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PROCARE PHARMACY, L.L.C.
DSH330194 MAIMONIDES MEDICAL CENTER
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Covered Entity Details
Entity Name
MAIMONIDES MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330194
Entity Address
4802 TENTH AVE.
BROOKLYN, NY 11219
Medicare Provider Number
330194
Participating Start Date
10/1/2004
Last Recertification Date
8/30/2024
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
10/17/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John P Marshall, Chief Medical Officer
(718) 283-6028
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/17/2023
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