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PROCARE PHARMACY, L.L.C.
RRC130013-00 ST. ALPHONSUS MEDICAL CENTER - NAMP
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Covered Entity Details
Entity Name
ST. ALPHONSUS MEDICAL CENTER - NAMP
Subdivision Name
Type
Rural Referral Center
340B ID
RRC130013-00
Entity Address
4300 East Flamingo Ave
NAMPA, ID 83687
Medicare Provider Number
130013
Participating Start Date
4/1/2025
Last Recertification Date
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
2/28/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2025
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