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PROCARE PHARMACY, L.L.C.
RRC490120-00 CHESAPEAKE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
CHESAPEAKE GENERAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC490120-00
Entity Address
736 BATTLEFIELD BLVD. NORTH
CHESAPEAKE, VA 23320
Medicare Provider Number
490120
Participating Start Date
8/27/2021
Last Recertification Date
8/19/2024
Entity Termination Date
1/1/2025
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
7/6/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Reese Jackson, President and CEO
(757) 312-8121
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/6/2022
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