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PROCARE PHARMACY, L.L.C.
DSH440053 SAINT THOMAS RUTHERFORD HOSPITAL
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Covered Entity Details
Entity Name
SAINT THOMAS RUTHERFORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440053
Entity Address
1700 MEDICAL CENTER PKWY
MURFREESBORO, TN 37129
Medicare Provider Number
440053
Participating Start Date
7/1/2022
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
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lisa Davis, Saint Thomas Health/Nashville/CEO
(615) 284-6845
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/6/2023
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