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PROCARE PHARMACY, L.L.C.
CAH151332-00 DECATUR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
DECATUR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151332-00
Entity Address
720 NORTH LINCOLN STREET
GREENSBURG, IN 47240
Medicare Provider Number
151332
Participating Start Date
8/18/2010
Last Recertification Date
8/20/2024
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
1/9/2023
Contract Begin Date
1/24/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rex McKinney, CEO
(812) 663-1171
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/9/2023
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