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PROCARE PHARMACY, L.L.C.
DSH390178 UPMC HORIZON HOSPITAL
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Covered Entity Details
Entity Name
UPMC HORIZON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390178
Entity Address
110 NORTH MAIN STREET
GREENVILLE, PA 16125
Medicare Provider Number
390178
Participating Start Date
4/1/2017
Last Recertification Date
9/5/2024
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
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Tracy, Jr., CFO
(724) 656-4107
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/16/2024
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