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PROCARE PHARMACY, L.L.C.
DSH180050 HARLAN ARH HOSPITAL
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Covered Entity Details
Entity Name
HARLAN ARH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180050
Entity Address
81 BALL PARK ROAD
HARLAN, KY 40831
Medicare Provider Number
180050
Participating Start Date
4/1/2005
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203
Pharmacy Comments
Contract Details
Approval Date
1/7/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hollie P Harris, President & CEO
(859) 226-2511
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/7/2022
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