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PROCARE PHARMACY DIRECT, L.L.C.
DSH210062 MEDSTAR SOUTHERN MARYLAND HOSPITAL C
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Covered Entity Details
Entity Name
MEDSTAR SOUTHERN MARYLAND HOSPITAL C
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210062
Entity Address
7503 SURRATTS ROAD
CLINTON, MD 20735
Medicare Provider Number
210062
Participating Start Date
10/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY DIRECT, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
105 MALL BOULEVARD
MONROEVILLE, PA 15146
Pharmacy Comments
12/11/2009 - PHARMACY MOVED FROM 600 PENN CENTER BLVD., PITTSBURGH, PA 15235-5810 AND NAME CHANGE (WAS PROCARE PHARMACY DIRECT, INC DBA PHARMACARE SPECIALTY PHARMACY)
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/8/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel M. Feeley, Interim Chief Financial Officer
(301) 877-5527
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2017
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