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PROCARE PHARMACY, L.L.C.
DSH050393 PIH HEALTH DOWNEY HOSPITAL
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Covered Entity Details
Entity Name
PIH HEALTH DOWNEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050393
Entity Address
11500 BROOKSHIRE AVENUE
DOWNEY, CA 90241-7010
Medicare Provider Number
050393
Participating Start Date
7/1/2021
Last Recertification Date
8/15/2024
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
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES R. WEST, PRESIDENT and CEO
(562) 698-0811 Ext: 12413
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2022
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