Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
CAH011306-00 Tanner Medical Center Alabama, Inc.

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 #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203

Pharmacy Comments

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

340B Drug Pricing Program Database