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PROCARE PHARMACY, L.L.C.
CAH131327-00 Gritman Medical Center
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Covered Entity Details
Entity Name
Gritman Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131327-00
Entity Address
700 S Main St
Moscow, ID 83843
Medicare Provider Number
131327
Participating Start Date
7/1/2013
Last Recertification Date
8/28/2024
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
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kara Besst, CEO
(208) 883-2220
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/16/2023
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