Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
BON SECOURS ST. FRANCIS XAVIER HOSPI

Covered Entity Details

Entity Name

BON SECOURS ST. FRANCIS XAVIER HOSPI

Subdivision Name

Type

Rural Referral Center

340B ID

Entity Address

2095 HENRY TECKLENBURG DRIVE
CHARLESTON, SC 29414

Medicare Provider Number

420065

Participating Start Date

Last Recertification Date

Pharmacy Details

Pharmacy Name

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY #2909
1521 4TH AVE., SOUTH
BIRMINGHAM, AL 35233

Pharmacy Comments

Contract Details

Approval Date

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Rebecca Ann Tucker, SVP, Chief Financial Officer
(843) 727-3403

Contract Pharmacy Representative

Bon Secours Saint Francis Hospital
Louis Glavinos, 340B Pharmacy Manager and Oncology Outpatient Pharmacy Infusion Manager
(843) 402-1675

Signed By Date

4/23/2025

340B Drug Pricing Program Database