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PROCARE PHARMACY, L.L.C.
DSH330057 ST. PETERS HOSPITAL
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Covered Entity Details
Entity Name
ST. PETERS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330057
Entity Address
315 S. MANNING BLVD.
ALBANY, NY 12208
Medicare Provider Number
330057
Participating Start Date
4/1/2024
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY #48637
2700 NORTHEAST EXPY NE STE B800
BUILDING B
ATLANTA, GA 30345
Pharmacy Comments
Contract Details
Approval Date
4/9/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lori Santos, CFO
(518) 525-5537
Contract Pharmacy Representative
CVS
Christian Reed, Sr. Director
(401) 770-2118
Signed By Date
4/9/2025
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