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PROCARE PHARMACY, L.L.C.
SCH260025-00 HANNIBAL REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
HANNIBAL REGIONAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260025-00
Entity Address
6000 HOSPITAL DRIVE
HANNIBAL, MO 63401
Medicare Provider Number
260025
Participating Start Date
10/1/2023
Last Recertification Date
8/19/2024
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
10/4/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rob Gasaway, VP-Finance/CFO
(573) 406-1608
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/4/2024
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