Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
RRC270014-00 ST PATRICK HOSPITAL

Covered Entity Details

Entity Name

ST PATRICK HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC270014-00

Entity Address

500 W. BROADWAY ST
MISSOULA, MT 59802

Medicare Provider Number

270014

Participating Start Date

7/1/2021

Last Recertification Date

8/25/2021

Entity Termination Date

10/1/2022

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

4/15/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kirk Bodlovic, Chief Operating Officer
(406) 327-1740

Contract Pharmacy Representative

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

Signed By Date

4/15/2022

340B Drug Pricing Program Database