Contract Pharmacy Details

PROCARE PHARMACY DIRECT, L.L.C.
DSH260011 SSM HEALTH-ST. MARYS-JEFFERSON CITY

Covered Entity Details

Entity Name

SSM HEALTH-ST. MARYS-JEFFERSON CITY

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH260011

Entity Address

2505 Mission Drive
JEFFERSON CITY, MO 65109

Medicare Provider Number

260011

Participating Start Date

7/1/2022

Last Recertification Date

9/1/2024

Entity Termination Date

7/1/2025

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

7/4/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Karen D. Rewerts, System VP of Finance
(557) 203-3614

Contract Pharmacy Representative

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

Signed By Date

7/4/2022

340B Drug Pricing Program Database