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PROCARE PHARMACY DIRECT, L.L.C.
DSH050231 POMONA VALLEY HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
POMONA VALLEY HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050231
Entity Address
1798 NORTH GAREY AVENUE
POMONA, CA 91767
Medicare Provider Number
050231
Participating Start Date
1/1/2007
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY DIRECT, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
105 MALL BOULEVARD
MONROEVILLE, PA 15146
Pharmacy Comments
12/11/2009 - PHARMACY MOVED FROM 600 PENN CENTER BLVD., PITTSBURGH, PA 15235-5810 AND NAME CHANGE (WAS PROCARE PHARMACY DIRECT, INC DBA PHARMACARE SPECIALTY PHARMACY)
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RICHARD YOCHUM, CEO
(909) 865-9500 Ext: 9975
Contract Pharmacy Representative
CVS HEALTH
Joan O'Rourke, VP Specialty Program Management
(847) 559-5282
Signed By Date
7/15/2016
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