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PROCARE PHARMACY, L.L.C.
RRC440011-00 BLOUNT MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BLOUNT MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC440011-00
Entity Address
907 E LAMAR ALEXANDER PKWY
MARYVILLE, TN 37804
Medicare Provider Number
440011
Participating Start Date
4/1/2023
Last Recertification Date
8/13/2024
Entity Termination Date
1/1/2025
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
7/7/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/22/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jonathan Smith, Interim CEO
(865) 977-5532
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/7/2023
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