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PROCARE PHARMACY DIRECT, L.L.C.
DSH170040 UNIVERSITY OF KANSAS HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF KANSAS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH170040
Entity Address
4000 Cambridge Street
Kansas City, KS 66160
Medicare Provider Number
170040
Participating Start Date
10/1/2000
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY DIRECT, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
105 MALL BOULEVARD
MONROEVILLE, PA 15146
Pharmacy Comments
12/11/2009 - PHARMACY MOVED FROM 600 PENN CENTER BLVD., PITTSBURGH, PA 15235-5810 AND NAME CHANGE (WAS PROCARE PHARMACY DIRECT, INC DBA PHARMACARE SPECIALTY PHARMACY)
Contract Details
Approval Date
1/11/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TAMMY PETERMAN, EXECUTIVE VP, COO, CHIEF NURSING OFFICER
(913) 588-1270
Contract Pharmacy Representative
University of Kansas Health System
Rick Couldry, Vice-President, Pharmacy and Clinical Professions
(913) 588-2301
Signed By Date
1/11/2017
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