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PROCARE PHARMACY DIRECT, L.L.C.
CAH171362-00 Citizens Medical Center, Inc.
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Covered Entity Details
Entity Name
Citizens Medical Center, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171362-00
Entity Address
100 E College Drive
Colby, KS 67701
Medicare Provider Number
171362
Participating Start Date
7/1/2013
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY DIRECT, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
105 MALL BOULEVARD
MONROEVILLE, PA 15146
Pharmacy Comments
12/11/2009 - PHARMACY MOVED FROM 600 PENN CENTER BLVD., PITTSBURGH, PA 15235-5810 AND NAME CHANGE (WAS PROCARE PHARMACY DIRECT, INC DBA PHARMACARE SPECIALTY PHARMACY)
Contract Details
Approval Date
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/9/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Greg Unruh, CEO
(785) 462-7511
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2022
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