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PROCARE PHARMACY, L.L.C.
DSH180093 Baptist Health Deaconess Madisonville
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Covered Entity Details
Entity Name
Baptist Health Deaconess Madisonville
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180093
Entity Address
900 HOSPITAL DRIVE
MADISONVILLE, KY 42431
Medicare Provider Number
180093
Participating Start Date
1/1/2005
Last Recertification Date
9/3/2024
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
4/3/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Ashby, Vice President of Finance
(270) 825-5781
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/3/2023
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