Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH270051 KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER

Covered Entity Details

Entity Name

KALISPELL REGIONAL MEDICAL CENTER d/b/a LOGAN HEALTH MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH270051

Entity Address

310 SUNNYVIEW LANE
KALISPELL, MT 59901

Medicare Provider Number

270051

Participating Start Date

1/1/2021

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #2926
1001 MADISON ST.
SEATTLE, WA 98104

Pharmacy Comments

Contract Details

Approval Date

7/14/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

CRAIG O BOYER, Chief Financial Officer
(406) 751-5368

Contract Pharmacy Representative

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

Signed By Date

7/14/2022

340B Drug Pricing Program Database