Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH330065 NIAGARA FALLS MEMORIAL MEDICAL CENTER

Covered Entity Details

Entity Name

NIAGARA FALLS MEMORIAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330065

Entity Address

621-10TH STREET
NIAGARA FALLS, NY 14302

Medicare Provider Number

330065

Participating Start Date

10/1/2006

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 2919
126 EIGHTH AVE.
NEW YORK, NY 10011

Pharmacy Comments

Contract Details

Approval Date

7/14/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Raj Mehta, CFO/Vice President of Finance
(716) 278-4399

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/14/2017

340B Drug Pricing Program Database