Covered Entity Details

RRC420065-00 BON SECOURS ST. FRANCIS XAVIER HOSPI (Approved) - information as of 5/20/2025 12:49:21 AM

Main Details

Name

BON SECOURS ST. FRANCIS XAVIER HOSPI

Subdivision Name

Type

Rural Referral Center

Rural

340B ID

RRC420065-00

Medicare Provider Number

420065

Additional Details

Current Program Status

Approved

Registration Date

4/15/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/25/2025

Last Recertification Date

Contacts

Authorizing Official

Roper St Francis Healthcare
Rebecca Ann Tucker, SVP, Chief Financial Officer
(843) 727-3403

Primary Contact

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

Addresses

Street Address

2095 HENRY TECKLENBURG DRIVE
CHARLESTON, SC 29414

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
SC	381885	1851361778

Shipping Addresses

Shipping Address 1

BON SECOURS - ST. FRANCIS XAVIER HOSPITAL
2095 HENRY TECKLENBURG DR
CHARLESTON, SC 29414-5733

Shipping Address 2

Charleston Oncology N Charleston - A Department of Bon Secours St Francis Xavier Hospital
2910 Tricom Street
North Charleston, SC 29406-9350

Shipping Address 3

Lowcountry Hematology & Oncology N Charleston
8950 University Blvd
STE 100
North Charleston, SC 29406-9891

Shipping Address 4

Charleston Oncology Berkeley
300 Callen Blvd
STE 110
Summerville, SC 29486-2816

Shipping Address 5

Lowcountry Hematology & Oncology Mt Pleasant A Department of Bon Secours St Francis Xavier Hospital
3510 N Highway 17
STE 225
Mount Pleasant, SC 29466-8233

Shipping Address 6

Charleston Oncology Mt Pleasant A Department of Bon Secours St Francis Xavier Hospital
3510 N Highway 17
STE 300
Mount Pleasant, SC 29466-8230

Shipping Address 7

Charleston Oncology West Ashley A Department of Bon Secours St Francis Xavier Hospital
2085 Henry Tecklenburg Dr
FL 2
Charleston, SC 29414-7710

Shipping Address 8

Lowcountry Hematology & Oncology Berkeley A Department of Bon Secours St Francis Xavier Hospital
300 Callen Blvd
210
Summerville, SC 29486-2816

Shipping Address 9

Roper St Francis Healthcare Bon Secours St Francis Hospital (Charleston Oncology DT)
316 Calhoun St
5600
Charleston, SC 29401-1113

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/25/2025	07/01/2025	04/25/2025
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/25/2025	07/01/2025	04/25/2025
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/25/2025	07/01/2025	04/25/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/25/2025	07/01/2025	04/25/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/25/2025	07/01/2025	04/25/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/25/2025	07/01/2025	04/25/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/25/2025	07/01/2025	04/25/2025
Contract Detail	BIOLOGICS, INC.	BIOLOGICS BY MCKESSON	11800 WESTON PARKWAY	CARY	NC	27513	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 16858	7 STONY HILL RD	BETHEL	CT	06801	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/25/2025	07/01/2025	04/25/2025
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/25/2025	07/01/2025	04/25/2025
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/25/2025	07/01/2025	04/25/2025
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/25/2025	07/01/2025	04/25/2025
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/25/2025	07/01/2025	04/25/2025
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/25/2025	07/01/2025	04/25/2025
Contract Detail	HARNESS HEALTH PHARMACY	7160 INDUSTRIAL ROW DR STE 331		MASON	OH	45040	04/25/2025	07/01/2025	04/25/2025
Contract Detail	HARNESS HEALTH PHARMACY	7160 INDUSTRIAL ROW DR	SUITE 330	MASON	OH	45040	04/25/2025	07/01/2025	04/25/2025
Contract Detail	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/25/2025	07/01/2025	04/25/2025
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/25/2025	07/01/2025	04/25/2025
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/25/2025	07/01/2025	04/25/2025
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/25/2025	07/01/2025	04/25/2025
Contract Detail	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	04/25/2025	07/01/2025	04/25/2025
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/25/2025	07/01/2025	04/25/2025
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/25/2025	07/01/2025	04/25/2025
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/25/2025	07/01/2025	04/25/2025
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/25/2025	07/01/2025	04/25/2025
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/25/2025	07/01/2025	04/25/2025
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/25/2025	07/01/2025	04/25/2025
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/25/2025	07/01/2025	04/25/2025
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/25/2025	07/01/2025	04/25/2025
Contract Detail	ROPER ST. FRANCIS PHYSICIAN PARTNERS	ROPER ST. FRANCIS PHARMACY, WEST ASHLEY	2085 HENRY TECKLENBURG DR STE 102	CHARLESTON	SC	29414	04/25/2025	07/01/2025	04/25/2025
Contract Detail	ROPER ST. FRANCIS PHYSICIAN PARTNERS	ROPER ST. FRANCIS PHARMACY BERKELEY	2910 TRICOM ST STE C	CHARLESTON	SC	29406	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00563	1515 OLD TROLLEY RD	SUMMERVILLE	SC	29485	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00529	2803 MAYBANK HWY	JOHNS ISLAND	SC	29455	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03977	1506 EAST MONTAGUE AVE	NORTH CHARLESTON	SC	29405	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05386	8523 OLD STATE ROAD, POB 730	HOLLY HILL	SC	29059	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03801	2152 SAVANNAH HWY.	CHARLESTON	SC	29414	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06958	9625 HWY 78	LADSON	SC	29456	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03560	1020 ORANGE GROVE ROAD	CHARLESTON	SC	29407	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03113	1602 CENTRAL AVE.	SUMMERVILLE	SC	29483	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02243	2566 ASHELY RIVER ROAD	CHARLESTON	SC	29414	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07537	5215 ASHLEY PHOSPHATE RD.	NORTH CHARLESTON	SC	29418	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03870	4400 DORCHESTER RD	CHARLESTON	SC	29405	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07398	#9 CORPORATE PARKWAY	GOOSE CREEK	SC	29445	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00443	1739 MAYBANK HWY	CHARLESTON	SC	29412	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07568	1055 RED BANK ROAD	GOOSE CREEK	SC	29445	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07016	10317 OCEAN HIGHWAY 17 SOUTH	PAWLEYS ISLAND	SC	29585	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07695	6323 SAVANNAH HWY, UNIT D	RAVENEL	SC	29470	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05845	640 LONG POINT RD.	MT PLEASANT	SC	29464	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00528	3575 MAYBANK HIGHWAY SUITE K	JOHNS ISLAND	SC	29455	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05553	1401 BEN SAWYER BLVD.	MOUNT PLEASANT	SC	29464	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05548	5742 MEMORIAL BLVD.	SAINT GEORGE	SC	29477	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11003	225 FAISON ROAD	MOUNT PLEASANT	SC	29466	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04204	301 N MAIN ST	SUMMERVILLE	SC	29483	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07159	2884 HWY 17 NORTH	MT PLEASANT	SC	29466	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05555	8910 OLD NUMBER SIX HWY	SANTEE	SC	29142	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00626	8995 UNIVERSITY BLVD	NORTH CHARLESTON	SC	29406	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04395	10599 DORCHESTER RD.	SUMMERVILLE	SC	29485	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05580	1941 N. MAIN ST.	SUMMERVILLE	SC	29486	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04263	1676 NORTH HIGHWAY 17	MOUNT PLEASANT	SC	29464	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07305	65 SYCAMORE AVE	CHARLESTON	SC	29407	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03834	100 REMBERT DENNIS BLVD	MONCKS CORNER	SC	29461	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03564	1015 KING ST.	CHARLESTON	SC	29403	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06410	431 B ST. JAMES AVE SUITE I	GOOSE CREEK	SC	29445	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03585	555 ROBERTSON BLVD.	WALTERBORO	SC	29488	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00483	983 HARBORVIEW RD	CHARLESTON	SC	29412	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07795	650 JOHNNIE DODDS BLVD.	MOUNT PLEASANT	SC	29464	04/25/2025	07/01/2025	04/25/2025
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16730	2070 SAM RITTENBERG BLVD	CHARLESTON	SC	29407	04/25/2025	07/01/2025	04/25/2025
Contract Detail	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00255	1329 KEMPSVILLE RD.	CHESAPEAKE	VA	23320	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15024	7501 RIVERS AVENUE	NORTH CHARLESTON	SC	29406-4662	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA WALGREENS #15512	380 KING ST.	CHARLESTON	SC	29401	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	WALGREENS #18351	600 SAINT JAMES AVE	GOOSE CREEK	SC	29445	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07156	1810 N HWY 17	MT PLEASANT	SC	29464-3309	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15072	2903 NORTH HIGHWAY 17	MOUNT PLEASANT	SC	29466	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11434	1630 RED BANK RD.	GOOSE CREEK	SC	29445	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07702	9998 DORCHESTER RD.	SUMMERVILLE	SC	29485-8526	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA WALGREENS #15442	389 JOHNNIE DODDS BLVD.	MOUNT PLEASANT	SC	29464	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12782	1925 ASHLEY RIVER RD.	CHARLESTON	SC	29407	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01072	1120 N MAIN STREET	SUMMERVILLE	SC	29483-7326	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11270	1861 REMOUNT RD.	NORTH CHARLESTON	SC	29406-3288	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #21191	200 RUTLEDGE AVE	CHARLESTON	SC	29403	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	WALGREENS #18147	261 CALHOUN ST	CHARLESTON	SC	29401	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06076	8395 DORCHESTER RD	NORTH CHARLESTON	SC	29418	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	WALGREENS #17043	1115 OLD TOWNE RD	CHARLESTON	SC	29407	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15630	907 FOLLY RD	CHARLESTON	SC	29412-3919	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09542	1 SOUTH ALLIANCE DRIVE	GOOSE CREEK	SC	29445-7172	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06073	54 OLD TROLLEY ROAD	SUMMERVILLE	SC	29485	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12635	3621 SAVANNAH HWY.	JOHNS ISLAND	SC	29455	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #09738	1584 CENTRAL AVE.	SUMMERVILLE	SC	29483-5528	04/25/2025	07/01/2025	04/25/2025
Contract Detail	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/25/2025	07/01/2025	04/25/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/25/2025	07/01/2025	04/25/2025

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC420065-01	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - DT - RSFH Oncology - DT RSFH ONCOLOGY CLINIC	125 DOUGHTY ST	CHARLESTON	SC	Approved
RRC420065-02	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - WA - RSFH Oncology - WA RSFH ONCOLOGY CLINIC	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-03	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology WA - RSFH Oncology - WA RSFH ONCOLOGY INFUSION	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-04	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - WA - RSFH Rheumatology - WA RSFH RHEUMATOLOGY CLINIC	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-05	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - LCHO University - RSFH Oncology - NC RSFH INFUSION THERAPY	8950 UNIVERSITY BLVD	N CHARLESTON	SC	Approved
RRC420065-06	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	ST. FRANCIS HOSPITAL THERAPEUTIC RADIOLOGY - WA RSFH THERAPEUTIC RADIOLOGY	2085 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-07	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	ST FRANCIS HOSPITAL INFUSION THERAP - WA RSFH INFUSION THERAPY	2085 HENRY TECKLENBURG DRIVE	CHARLESTON	SC	Approved
RRC420065-08	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	ST FRANCIS HOSP PAIN MANAGEMENT EAST - WA RSFH PAIN MANAGEMENT	2093 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-09	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	ST FRANCIS HOSP BREAST CARE MEDICAL - WA RSFH MAMMOGRAPHY	2145 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-10	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology NC - RSFH Oncology - NC RSFH ONCOLOGY INFUSION	2910 TRICOM ST	N CHARLESTON	SC	Approved
RRC420065-11	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - NC - RSFH Oncology - NC RSFH ONCOLOGY CLINIC	2910 TRICOM ST	N CHARLESTON	SC	Approved
RRC420065-12	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology BK - RSFH Oncology - Charleston Oncology - BK RSFH ONCOLOGY INFUSION	300 CALLEN BLVD	SUMMERVILLE	SC	Approved
RRC420065-13	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - BK - RSFH Oncology - BK RSFH ONCOLOGY CLINIC	300 CALLEN BLVD	SUMMERVILLE	SC	Approved
RRC420065-14	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	RSFH INFUSION THERAPY BERKELEY A DEPARTMENT OF BON SECOURS ST FRANCIS XAVIER HOSPITAL - BK RSFH INFUSION THERAPY	300 CALLEN BLVD	SUMMERVILLE	SC	Approved
RRC420065-15	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology DT - RSFH Oncology - DT RSFH ONCOLOGY INFUSION	316 CALHOUN ST	CHARLESTON	SC	Approved
RRC420065-16	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	RSFH INFUSION THERAPY MT PLEASANT A DEPARTMENT OF BON SECOURS ST FRANCIS XAVIER HOSPITAL - MP RSFH INFUSION THERAPY	3510 N HIGHWAY 17	MT PLEASANT	SC	Approved
RRC420065-17	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - Infusion - RSF Oncology MP - MP RSFH ONCOLOGY INFUSION	3510 N HIGHWAY 17	MT PLEASANT	SC	Approved
RRC420065-18	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - MP - RSFH Oncology - MP RSFH ONCOLOGY CLINIC	3510 N HIGHWAY 17	MT PLEASANT	SC	Approved
RRC420065-19	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - RSF Oncology - WA - RSFH Oncology - WA RSFH ONCOLOGY CLINIC	2093 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved
RRC420065-20	Child	RRC	BON SECOURS ST. FRANCIS XAVIER HOSPI	BON SECOURS ST FRANCIS XAVIER HOSPI - WA - RSFH Cardiology - WA RSFH CARDIOLOGY CLINIC	2093 HENRY TECKLENBURG DR	CHARLESTON	SC	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	Hospital Type Change Request		Tucker, Rebecca Ann SVP, Chief Financial Officer Roper St Francis Healthcare 8437273403	4/25/2025 9:00 AM
Details	340B ID	Update	Hospital Type Change Request		RRC420065-00	4/25/2025 9:00 AM
Dates	Participating Approval Date	Update	Hospital Type Change Request		4/25/2025 9:00:05 AM	4/25/2025 9:00 AM
Details	State	Update	Hospital Type Change Request	Pending	Approved	4/25/2025 9:00 AM
Dates	Signed By Date	Update	Hospital Type Change Request		4/18/2025 3:33:59 PM	4/25/2025 9:00 AM
Dates	Start Date	Update	Hospital Type Change Request		7/1/2025 12:00:00 AM	4/25/2025 9:00 AM
Addresses	Main Address	Insert	Hospital Type Change Request		2095 HENRY TECKLENBURG DRIVE CHARLESTON, SC 29414	4/15/2025 11:24 AM
Addresses	Shipping Address	Insert	Hospital Type Change Request		BON SECOURS - ST. FRANCIS XAVIER HOSPITAL 2095 HENRY TECKLENBURG DR CHARLESTON, SC 29414-5733	4/15/2025 11:24 AM
Addresses	Shipping Address	Insert	Hospital Type Change Request		Charleston Oncology N Charleston - A Department of Bon Secours St Francis Xavier Hospital 2910 Tricom Street North Charleston, SC 29406-9350	4/15/2025 11:24 AM
Addresses	Shipping Address	Insert	Hospital Type Change Request		Lowcountry Hematology & Oncology N Charleston 8950 University Blvd STE 100 North Charleston, SC 29406-9891	4/15/2025 11:24 AM
Addresses	Shipping Address	Insert	Hospital Type Change Request		Charleston Oncology Berkeley 300 Callen Blvd STE 110 Summerville, SC 29486-2816	4/15/2025 11:24 AM
Addresses	Shipping Address	Insert	Hospital Type Change Request		Lowcountry Hematology & Oncology Mt Pleasant A Department of Bon Secours St Francis Xavier Hospital 3510 N Highway 17 STE 225 Mount Pleasant, SC 29466-8233	4/15/2025 11:24 AM
Addresses	Shipping Address	Insert	Hospital Type Change Request		Charleston Oncology Mt Pleasant A Department of Bon Secours St Francis Xavier Hospital 3510 N Highway 17 STE 300 Mount Pleasant, SC 29466-8230	4/15/2025 11:24 AM
Addresses	Shipping Address	Insert	Hospital Type Change Request		Charleston Oncology West Ashley A Department of Bon Secours St Francis Xavier Hospital 2085 Henry Tecklenburg Dr FL 2 Charleston, SC 29414-7710	4/15/2025 11:24 AM
Addresses	Shipping Address	Insert	Hospital Type Change Request		Lowcountry Hematology & Oncology Berkeley A Department of Bon Secours St Francis Xavier Hospital 300 Callen Blvd 210 Summerville, SC 29486-2816	4/15/2025 11:24 AM
Addresses	Shipping Address	Insert	Hospital Type Change Request		Roper St Francis Healthcare Bon Secours St Francis Hospital (Charleston Oncology DT) 316 Calhoun St 5600 Charleston, SC 29401-1113	4/15/2025 11:24 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Hospital Type Change Request		False	4/15/2025 11:24 AM
Medicaid Billing	Medicaid: Number	Insert	Hospital Type Change Request		381885	4/15/2025 11:24 AM
Medicaid Billing	Medicaid: State	Insert	Hospital Type Change Request		SC	4/15/2025 11:24 AM
Medicaid Billing	NPI: Number	Insert	Hospital Type Change Request		1851361778	4/15/2025 11:24 AM
Medicaid Billing	NPI: State	Insert	Hospital Type Change Request		SC	4/15/2025 11:24 AM
Contacts	Primary Contact	Insert	Hospital Type Change Request		Glavinos, Louis 340B Pharmacy Manager and Oncology Outpatient Pharmacy Infusion Manager Bon Secours Saint Francis Hospital 8434021675	4/15/2025 11:24 AM
Contacts	Authorizing Official	Insert	Hospital Type Change Request		Tucker, Rebecca Ann SVP, Chief Financial Officer Roper St Francis Healthcare 8437273403	4/15/2025 11:24 AM
Details	Assistance Received From Date	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Details	Assistance Received To Date	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Details	Last Recertification Date	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Details	Grant Number	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Details	340B ID	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Details	Is Authorizing Official EHB Data	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Dates	Last Date That 340B Drugs Purchased	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Details	Medicare Provider Number	Insert	Hospital Type Change Request		420065	4/15/2025 11:24 AM
Details	Entity Name	Insert	Hospital Type Change Request		BON SECOURS ST. FRANCIS XAVIER HOSPI	4/15/2025 11:24 AM
Details	NOFO Number	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Details	Program Code	Insert	Hospital Type Change Request		RRC	4/15/2025 11:24 AM
Details	Entity Subname	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Dates	Participating Approval Date	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Details	State	Insert	Hospital Type Change Request		Pending	4/15/2025 11:24 AM
Dates	Registration Date	Insert	Hospital Type Change Request		4/15/2025 11:24:27 AM	4/15/2025 11:24 AM
Dates	Signed By Date	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Dates	Start Date	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Terminations	Termination Comments	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Terminations	Termination Date	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Terminations	Termination Effective Date	Insert	Hospital Type Change Request			4/15/2025 11:24 AM
Terminations	Termination Reason	Insert	Hospital Type Change Request			4/15/2025 11:24 AM