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PROCARE PHARMACY, L.L.C.
PED063301-00 Children's Hospital Colorado
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Covered Entity Details
Entity Name
Children's Hospital Colorado
Subdivision Name
Type
Children's Hospital
340B ID
PED063301-00
Entity Address
13123 EAST 16TH AVENUE
AURORA, CO 80045
Medicare Provider Number
063301
Participating Start Date
9/9/2010
Last Recertification Date
9/4/2024
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
4/5/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Casey Dugan, Vice President of Pharmacy Services
(720) 777-5683
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/5/2024
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