Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
DSH210043 BALTIMORE WASHINGTON MEDICAL CENTER

Covered Entity Details

Entity Name

BALTIMORE WASHINGTON MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210043

Entity Address

301 HOSPITAL DRIVE
GLEN BURNIE, MD 21061

Medicare Provider Number

210043

Participating Start Date

1/1/2025

Last Recertification Date

Entity Termination Date

1/1/2025

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

10/10/2024

Contract Begin Date

1/1/2025

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

William Brett McCone, SVP, Finance
(410) 787-4529

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/8/2024

340B Drug Pricing Program Database