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PROCARE PHARMACY, L.L.C.
CAH491305-00 SHENANDOAH MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SHENANDOAH MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH491305-00
Entity Address
759 SOUTH MAIN STREET
WOODSTOCK, VA 22664
Medicare Provider Number
491305
Participating Start Date
9/27/2010
Last Recertification Date
8/23/2024
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
Peter F. Gallagher, CFO
(540) 536-8031
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2022
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