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PROCARE PHARMACY, L.L.C.
RRC250141-00 BAPTIST MEM HOSPITAL DESOTO
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Covered Entity Details
Entity Name
BAPTIST MEM HOSPITAL DESOTO
Subdivision Name
Type
Rural Referral Center
340B ID
RRC250141-00
Entity Address
7601 SOUTHCREST
SOUTHAVEN, MS 38671
Medicare Provider Number
250141
Participating Start Date
11/12/2020
Last Recertification Date
8/28/2024
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
1/14/2022
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
1/14/2022
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