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PROCARE PHARMACY, L.L.C.
DSH070016 Saint Mary's Hospital
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Covered Entity Details
Entity Name
Saint Mary's Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070016
Entity Address
56 Franklin Street
Waterbury, CT 06706
Medicare Provider Number
070016
Participating Start Date
4/1/2014
Last Recertification Date
8/23/2024
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
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Antonio Perugino, Regional Chief Financial Officer
(860) 714-5360
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2025
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