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PROCARE PHARMACY, L.L.C.
DSH230038 Corewell Health Grand Rapids Hospitals Butterworth Hospital
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Covered Entity Details
Entity Name
Corewell Health Grand Rapids Hospitals Butterworth Hospital
Subdivision Name
BUTTERWORTH HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH230038
Entity Address
100 MICHIGAN STREET NE
GRAND RAPIDS, MI 49503-2560
Medicare Provider Number
230038
Participating Start Date
4/1/2004
Last Recertification Date
8/27/2024
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
1/17/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hardik Dalal, SVP, Finance & System-wide Pharmacy Finance
(312) 771-0810
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2024
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