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PROCARE PHARMACY, L.L.C.
DSH390115 Jefferson Health Northeast
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Covered Entity Details
Entity Name
Jefferson Health Northeast
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390115
Entity Address
10800 Knights Rd.
PHILADELPHIA, PA 19114
Medicare Provider Number
390115
Participating Start Date
10/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 02553
1117 WALNUT ST.
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
7/5/2022
Contract Begin Date
7/11/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CARRIE FREY, Director of Finance
(215) 612-4313
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/5/2022
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