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PROCARE PHARMACY, L.L.C.
DSH470011 Brattleboro Memorial Hospital
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Covered Entity Details
Entity Name
Brattleboro Memorial Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH470011
Entity Address
17 Belmont Avenue
Brattleboro, VT 05301
Medicare Provider Number
470011
Participating Start Date
7/1/2014
Last Recertification Date
9/4/2024
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
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laura Bruno, Interium Chief Financial Officer
(802) 257-8385
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2025
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