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PROCARE PHARMACY, L.L.C.
DSH050043 Sutter Bay Hospitals, dba Alta Bates Summit Medical Center
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Covered Entity Details
Entity Name
Sutter Bay Hospitals, dba Alta Bates Summit Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050043
Entity Address
350 HAWTHORNE AVENUE
OAKLAND, CA 94609
Medicare Provider Number
050043
Participating Start Date
7/1/2006
Last Recertification Date
8/27/2024
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
10/25/2022
Contract Begin Date
11/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Dorius Clark, Area CEO
(510) 869-6703
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/25/2022
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