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PROCARE PHARMACY, L.L.C.
DSH390063 UPMC HAMOT
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Covered Entity Details
Entity Name
UPMC HAMOT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390063
Entity Address
201 STATE STREET
ERIE, PA 16550
Medicare Provider Number
390063
Participating Start Date
4/1/2015
Last Recertification Date
9/6/2024
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
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brad N Dinger, CFO
(814) 877-3739
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2024
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