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PROCARE PHARMACY, L.L.C.
CAH011306-00 Tanner Medical Center Alabama, Inc.
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Covered Entity Details
Entity Name
Tanner Medical Center Alabama, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH011306-00
Entity Address
1032 South Main Street
Wedowee, AL 36278
Medicare Provider Number
011306
Participating Start Date
7/1/2019
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY OR CARELONRX SPECIALTY
ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULU, HI 96813
Pharmacy Comments
3/22/10 NAME CORRECTION (WAS CVS PROCARE PHARMACY DBA CVS PROCARE PHARMACY #2915) 3/17/10 ADDR CHANGE (WAS 970 N KALAHEO AVE, SUITE A 203)
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carol S. Crews, CFO
(770) 812-9745
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2022
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