Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH050262 RONALD REAGAN UCLA MEDICAL CENTER

Covered Entity Details

Entity Name

RONALD REAGAN UCLA MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050262

Entity Address

757 WESTWOOD PLAZA
LOS ANGELES, CA 90095

Medicare Provider Number

050262

Participating Start Date

1/1/1998

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY #2909
1521 4TH AVE., SOUTH
BIRMINGHAM, AL 35233

Pharmacy Comments

Contract Details

Approval Date

4/13/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Paul Staton, CFO
(310) 267-9308

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/13/2022

340B Drug Pricing Program Database