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PROCARE PHARMACY, L.L.C.
DSH040118 NEA BAPTIST MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
NEA BAPTIST MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040118
Entity Address
4800 EAST JOHNSON AVENUE
JONESBORO, AR 72405
Medicare Provider Number
040118
Participating Start Date
4/28/2020
Last Recertification Date
8/26/2024
Entity Termination Date
7/1/2025
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
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kimberly Young, Vice President-Finance Operations
(901) 227-4080
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2022
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