Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH110078 EMORY UNIVERSITY HOSPITAL MIDTOWN

Covered Entity Details

Entity Name

EMORY UNIVERSITY HOSPITAL MIDTOWN

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110078

Entity Address

550 PEACHTREE STREET, NE
ATLANTA, GA 30308-2209

Medicare Provider Number

110078

Participating Start Date

4/1/2006

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #2686
560 AMSTERDAM AVE, STE #E
ATLANTA, GA 30306

Pharmacy Comments

Contract Details

Approval Date

7/17/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/20/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Greg E. Anderson, CFO
(404) 686-2823

Contract Pharmacy Representative

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

Signed By Date

7/17/2017

340B Drug Pricing Program Database