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PROCARE PHARMACY DIRECT, L.L.C.
DSH450102 CHRISTUS MOTHER FRANCES HOSP-TYLER
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Covered Entity Details
Entity Name
CHRISTUS MOTHER FRANCES HOSP-TYLER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450102
Entity Address
800 EAST DAWSON
TYLER, TX 75701
Medicare Provider Number
450102
Participating Start Date
3/10/2022
Last Recertification Date
8/27/2024
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
3/10/2022
Contract Begin Date
3/10/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elizabeth Pulliam, Chief Financial Officer
(903) 606-4102
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
3/1/2022
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