Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH130013 Saint Alphonsus Medical Center Nampa

Covered Entity Details

Entity Name

Saint Alphonsus Medical Center Nampa

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH130013

Entity Address

4300 East Flamingo Ave
NAMPA, ID 83687

Medicare Provider Number

130013

Participating Start Date

10/17/2005

Last Recertification Date

8/20/2024

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

1/12/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347

Contract Pharmacy Representative

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

Signed By Date

1/12/2024

340B Drug Pricing Program Database