Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH240115 MERCY HOSPITAL

Covered Entity Details

Entity Name

MERCY HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH240115

Entity Address

4050 COON RAPIDS BLVD
COON RAPIDS, MN 55433

Medicare Provider Number

240115

Participating Start Date

10/1/2019

Last Recertification Date

8/13/2024

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

10/9/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785

Contract Pharmacy Representative

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

Signed By Date

10/9/2023

340B Drug Pricing Program Database