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PROCARE PHARMACY, L.L.C.
DSH250100 BAPTIST MEMORIAL HOSPITAL-GOLDEN TRIANGLE
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Covered Entity Details
Entity Name
BAPTIST MEMORIAL HOSPITAL-GOLDEN TRIANGLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250100
Entity Address
2520 5TH STREET N
COLUMBUS, MS 39705-2008
Medicare Provider Number
250100
Participating Start Date
9/2/2008
Last Recertification Date
8/26/2024
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
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
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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