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PROCARE PHARMACY, L.L.C.
CAH051337-00 HAZEL HAWKINS MEM. HOSPITAL
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Covered Entity Details
Entity Name
HAZEL HAWKINS MEM. HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051337-00
Entity Address
911 SUNSET DRIVE
HOLLISTER, CA 95023
Medicare Provider Number
051337
Participating Start Date
10/1/2021
Last Recertification Date
9/3/2024
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
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARK ROBINSON, CFO
(831) 636-2604
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2024
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