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PROCARE PHARMACY, L.L.C.
RRC180104-00 BAPTIST HEALTH PADUCAH
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Covered Entity Details
Entity Name
BAPTIST HEALTH PADUCAH
Subdivision Name
Type
Rural Referral Center
340B ID
RRC180104-00
Entity Address
2501 KENTUCKY AVENUE
PADUCAH, KY 42003
Medicare Provider Number
180104
Participating Start Date
1/1/2025
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
4/1/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kenneth Boyd, President
(270) 575-2101
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/1/2025
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