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PROCARE PHARMACY, L.L.C.
DSH200008 MERCY HOSPITAL
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Covered Entity Details
Entity Name
MERCY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200008
Entity Address
175 Fore River Parkway
PORTLAND, ME 04102
Medicare Provider Number
200008
Participating Start Date
4/1/2022
Last Recertification Date
9/4/2024
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
1/27/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Kennedy, VP of Finance
(207) 879-3363
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/18/2022
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