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PROCARE PHARMACY, L.L.C.
DSH050455 Adventist Health Bakersfield
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Covered Entity Details
Entity Name
Adventist Health Bakersfield
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050455
Entity Address
2615 Chester Avenue
BAKERSFIELD, CA 93301
Medicare Provider Number
050455
Participating Start Date
4/1/2005
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
4/6/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shane H Cox, Finance Officer
(661) 869-6180
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/6/2022
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