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PROCARE PHARMACY, L.L.C.
RRC330094-00 Columbia Memorial Hospital
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Covered Entity Details
Entity Name
Columbia Memorial Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC330094-00
Entity Address
71 Prospect Aveune
Hudson, NY 12534
Medicare Provider Number
330094
Participating Start Date
10/1/2013
Last Recertification Date
9/6/2024
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
1/12/2023
Contract Begin Date
2/15/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bryan T. Mahoney, Chief Financial Officer
(518) 697-3230
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2023
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