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PROCARE PHARMACY, L.L.C.
CAH431325-00 Mobridge Regional Hospital
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Covered Entity Details
Entity Name
Mobridge Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431325-00
Entity Address
1401 10th Avenue West
Mobridge, SD 57601
Medicare Provider Number
431325
Participating Start Date
10/1/2013
Last Recertification Date
8/21/2024
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
7/1/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John J. Ayoub, CEO
(605) 845-8105
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/1/2024
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