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PROCARE PHARMACY, L.L.C.
DSH190006A UNIVERSITY HOSPITAL AND CLINICS
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Covered Entity Details
Entity Name
UNIVERSITY HOSPITAL AND CLINICS
Subdivision Name
Ophthalmology UHCP GR02 - USJC OPHTHALMOLOGY
Type
Disproportionate Share Hospital
340B ID
DSH190006A
Entity Address
401 St. Julien
Lafayette, LA 70506
Medicare Provider Number
190006
Outpatient Facility Provider Number
Participating Start Date
1/1/2014
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2751
426 S. HENDERSON STREET
FORT WORTH, TX 76104
Pharmacy Comments
Contract Details
Approval Date
1/21/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/23/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Katherine D. Hebert, Chief Executive Officer
(337) 261-6004
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/21/2022
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