340B Drug Pricing Program Database


DSH420049 CONWAY HOSPITAL (Active) - information as of 5/5/2025 11:58:50 PM

Main Details
CONWAY HOSPITAL
Disproportionate Share Hospital
No
DSH420049
420049


Additional Details
Active
4/10/2019
7/1/2019
4/17/2019
8/21/2024

Contacts

Conway Hospital
Angela Williford, Chief Administrative Officer
(843) 347-8166

Conway Hospital Inc dba Conway Medical Center
Brandie Nicole Thompson, Ambulatory Pharmacy Supervisor
(843) 455-8570

Addresses

300 SINGLETON RIDGE ROAD
CONWAY, SC 29526

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participating Start date 7/1/2005, Termination 7/1/2017, Reinstatement 7/1/201904/17/2019
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
SC17491801134172000
CO950178511134172000
CT0031209701134172000
MI11341720001134172000
NC11341720001134172000
OH04050851134172000
VA11341720001134172000
VT04200491134172000
Shipping Addresses

Conway Medical Center
300 Singleton Ridge Road
Conway, SC 29526
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750201/04/202404/01/2024  04/01/2024
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884901/04/202404/01/2024  04/01/2024
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201001/04/202404/01/2024  04/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349201/04/202404/01/2024  04/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/04/202404/01/2024  04/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282201/04/202404/01/2024  04/01/2024
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280904/02/202407/01/2024  07/01/2024
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/25/202302/23/2023 03/24/202503/28/2025
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/25/202302/23/2023  02/23/2023
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/25/202302/23/2023 03/24/202503/28/2025
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/25/202302/23/2023 03/24/202503/28/2025
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/25/202302/23/2023 03/24/202503/28/2025
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/25/202302/23/2023  02/23/2023
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/25/202302/23/2023  02/23/2023
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/25/202302/23/2023  02/23/2023
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/25/202302/23/2023 03/24/202503/28/2025
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/25/202302/23/2023 03/24/202503/28/2025
Contract DetailCAROLINA FOREST PHARMACY4036 RIVER OAKS DR UNIT B-1
MYRTLE BEACHSC2957904/15/202207/01/2022  07/01/2022
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/11/202310/01/2023  10/01/2023
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/11/202310/01/2023  10/01/2023
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/25/202302/23/2023  02/23/2023
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111201/04/202404/01/2024  04/01/2024
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313401/04/202404/01/2024  04/01/2024
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801601/04/202404/01/2024  04/01/2024
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607501/04/202404/01/2024  04/01/2024
Contract DetailHEALTH AND WELLNESS PHARMACY LLCD/B/A CAROLINA HEALTH PHARMACY 5405 DICK POND RD UNIT C1
MYRTLE BEACHSC2958804/15/202207/01/2022  07/01/2022
Contract DetailKROGER DRUGSTORE #0263735 RENEE DRIVE
MYRTLE BEACHSC2957901/15/202004/01/2020  04/01/2020
Contract DetailKROGER PHARMACY #0252939 S HIGHWAY 17
MURRELLS INLETSC2957601/15/202004/01/2020  04/01/2020
Contract DetailNOBLE HEALTH SERVICES INC.6040 TARBELL ROAD
SYRACUSENY1320601/15/202101/18/2021 10/16/202410/23/2024
Contract DetailNOBLE HEALTH SERVICES, INC.DBA TRANSCRIPT PHARMACY 2506 LAKELAND DR
STE 201 		FLOWOODMS39232-765601/15/202101/18/2021 10/16/202410/23/2024
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/25/202302/23/2023  02/23/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681301/25/202302/23/2023 03/24/202503/28/2025
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/25/202302/23/2023 03/24/202503/28/2025
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920301/25/202302/23/2023  02/23/2023
Contract DetailPROXSYS RX-SC, LLCD/B/A THE PHARMACY AT CMC 300 SINGLETON RIDGE RD
CONWAYSC2952610/04/201910/04/2019  10/04/2019
Contract DetailPUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY #3213 1950 SAND LAKE RD, BLDG #5
ORLANDOFL3280901/15/202004/01/2020 09/16/202409/23/2024
Contract DetailPUBLIX SUPER MARKETS, INC.PUBLIX PHARMACY #1510 2170 OAKHEART RD
MYRTLE BEACHSC2957901/15/202004/01/2020 09/16/202409/23/2024
Contract DetailPUBLIX SUPER MARKETS, INC.PUBLIX CENTRAL PHARMACY #3201 2424 ORLANDO CENTRAL PARKWAY
ORLANDOFL3280901/15/202004/01/2020 09/16/202409/23/2024
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104210/13/202001/01/2021  01/01/2021
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022310/13/202001/01/2021  01/01/2021
Contract DetailSORKIN'S RX LTDD/B/A CAREMED PHARMACEUTICAL SERVICES 1985 MARCUS AVE STE 130
NEW HYDE PARKNY11042-202410/13/202001/01/2021  01/01/2021
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01540 3411 SOCASTEE BLVD.
MYRTLE BEACHSC2958801/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08936 101 FOUNDERS BAY RD.
MURRELLS INLETSC2957601/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02736 3710 HIGHWAY 17 BYPASS
MURRELLS INLETSC2957601/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03851 707 CHURCH STREET
CONWAYSC2952601/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #175 578 INTERNATIONAL DR
MYRTLE BEACHSC2957901/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07531 206 S. MAIN ST./PO BOX 901
HEMINGWAYSC2955401/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07040 2492 HWY 9 EAST
LITTLE RIVERSC2956601/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07396 1010 HWY 17 NORTH
NORTH MYRTLE BEACHSC2958201/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03567 6617 NORTH KINGS HWY.
MYRTLE BEACHSC2957201/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.CVS PHARMACY # 16372 1150 SEABOARD ST
MYRTLE BEACHSC2957701/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05524 1370 HWY 17
LITTLE RIVERSC2956601/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.CVS PHARMACY # 17613 140 SAYEBROOK PKWY
MYRTLE BEACHSC2958801/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01140 101 FETLOCK DR.
MYRTLE BEACHSC2958801/25/202302/23/2023 03/23/202307/26/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03855 236 W. MCINTYRE ST.
MULLINSSC2957401/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05515 601 HWY 17 NORTH
SURFSIDE BEACHSC2957501/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01194 4767 BROAD ST.
LORISSC2956901/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07366 4401 HWY 17 SOUTH
NORTH MYRTLE BEACHSC2958201/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08492 930 82ND PKWY.
MYRTLE BEACHSC2957201/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07654 2996 E. HWY 501
CONWAYSC2952601/25/202302/23/2023  02/23/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05516 1303 38TH AVE. N.
MYRTLE BEACHSC2957707/11/202310/01/2023  10/01/2023
Contract DetailSOUTH CAROLINA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04150 700 N. MAIN ST
MARIONSC2957107/11/202310/01/2023  10/01/2023
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-05742751 BEAVER RUN BLVD
SURFSIDE (MYRTLE BEACH)SC2957501/15/202004/01/2020 12/12/202401/20/2025
Contract DetailWAL-MART PHARMACY 10-05862709-A CHURCH STREET
CONWAYSC2952601/15/202004/01/2020 12/12/202401/20/2025
Contract DetailWAL-MART PHARMACY 10-2712541SEABOARD STREET
MYRTLE BEACH (S)SC2957701/15/202004/01/2020 12/12/202401/20/2025
Contract DetailWAL-MART PHARMACY 10-4664151 MYRTLE RIDGE RD
CONWAYSC2952601/15/202004/01/2020  04/01/2020
Contract DetailWAL-MART PHARMACY 10-5705545 GARDEN CITY CONNECTOR
GARDEN CITY BEACHSC2957601/15/202004/01/2020 12/12/202401/20/2025
Contract DetailWAL-MART PHARMACY 10-59233650 WALTON DRIVE
MYRTLE BEACHSC2957701/15/202004/01/2020 12/12/202401/20/2025
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/15/202004/01/2020  04/01/2020
Contract DetailWALGREEN CO.DBA: WALGREENS # 06687 4300 HIGHWAY 17 SOUTH
NORTH MYRTLE BEACHSC29582-515704/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.WALGREENS #17460 1905 HIGHWAY 544
CONWAYSC2952604/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.WALGREENS #17422 7800 N KINGS HWY
MYRTLE BEACHSC2957204/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS SPECIALTY PHARMACY #21191 200 RUTLEDGE AVE
CHARLESTONSC2940304/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07956 11 N CAUSEWAY RD
PAWLEYS ISLANDSC2958504/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #13995 1110 DICK POND RD.
MYRTLE BEACHSC2957504/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.WALGREENS #16172 808 E 5TH ST
TABOR CITYNC2846304/07/202207/01/2022 03/24/202503/24/2025
Contract DetailWALGREEN CO.DBA: WALGREENS #10814 601 HWY. 17 N
NORTH MYRTLE BEACHSC29582-290504/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.WALGREENS #18359 600 HIGHWAY 17 S
NORTH MYRTLE BEACHSC2958204/07/202207/01/2022 05/04/202306/16/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07749 852 SUNSET BLVD NORTH
SUNSET BEACHNC28468-426204/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.WALGREENS #17258 5001 SOCASTEE BLVD
MYRTLE BEACHSC2958804/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 09834 1098 N FRASER ST
GEORGETOWNSC29440-284804/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07154 1601 CHURCH STREET
CONWAYSC29526-295904/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06077 2872 S HIGHWAY 17
MURRELLS INLETSC2957604/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 06877 4779 HWY 501
MYRTLE BEACHSC29579-944404/07/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #06898 3701 N. KINGS HIGHWAY
MYRTLE BEACHSC2957704/07/202207/01/2022  07/01/2022
Contract DetailWalgreens #21420Walgreens Central Fill #21420 8440 Times Dispatch Blvd
Ste. 400 		MechanicsvilleVA2311610/12/202301/01/2024  01/01/2024
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275601/04/202404/01/2024  04/01/2024
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/04/202404/01/2024  04/01/2024
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH420049AChildDSHCONWAY HOSPITALCMC Pediatrics - Socastee6010 Highway 707Myrtle BeachSCActive
DSH420049AAChildDSHCONWAY HOSPITALCMC Godwin Healing Center394 Singleton Ridge RoadConwaySCActive
DSH420049ABChildDSHCONWAY HOSPITALCMC Rheumatolgy300 Singleton Ridge RoadConwaySCActive
DSH420049ACChildDSHCONWAY HOSPITALCMC Primary Care - Market Common1600 Farrow ParkwayMyrtle BeachSCActive
DSH420049ADChildDSHCONWAY HOSPITALCMC Infectious Diseases2361 Cypress CircleConwaySCActive
DSH420049AEChildDSHCONWAY HOSPITALCMC Dermatology808 Farrar DriveConwaySCActive
DSH420049AFChildDSHCONWAY HOSPITALCMC Primary Care - Little River4237 River Hills DriveLittle RiverSCActive
DSH420049AGChildDSHCONWAY HOSPITALCMC Primary Care - Bellamy Avenue631 Bellamy AvenueMurrells InletSCActive
DSH420049AHChildDSHCONWAY HOSPITALCMC Primary Care - Prince Creek11899 Highway 707Murrells InletSCActive
DSH420049AJChildDSHCONWAY HOSPITALCMC Imaging Center Church Street - Diagnostic/Imaging2701 Church StreetConwaySCActive
DSH420049AKChildDSHCONWAY HOSPITALCMC Surgical Center South - Ambulatory Surgery Center6010 Highway 707Myrtle BeachSCActive
DSH420049ALChildDSHCONWAY HOSPITALCMC Women's Health - Socastee - OB/GYN6010 Highway 707Myrtle BeachSCActive
DSH420049AMChildDSHCONWAY HOSPITALCMC Weight Loss - Bariatrics2361 Cypress CircleConwaySCActive
DSH420049ANChildDSHCONWAY HOSPITALCMC Surgical Associates Socastee - Surgery Office6010 Highway 707Myrtle BeachSCActive
DSH420049APChildDSHCONWAY HOSPITALCMC Primary Care - Grande Dunes1100 62nd Ave NMyrtle BeachSCActive
DSH420049AQChildDSHCONWAY HOSPITALCMC Primary Care Church Street - Primary Care2701 Church StConwaySCActive
DSH420049ARChildDSHCONWAY HOSPITALCMC Infusion Center University Commons - Infusion Services201 Graduate RdConwaySCActive
DSH420049ASChildDSHCONWAY HOSPITALCMC Ear, Nose, and Throat - Socastee6010 Highway 707Myrtle BeachSCActive
DSH420049ATChildDSHCONWAY HOSPITALCMC Dermatology - Grande Dunes1100 62nd Ave NMyrtle BeachSCActive
DSH420049AUChildDSHCONWAY HOSPITALCMC Student Health at CCU251 University BlvdConwaySCActive
DSH420049AVChildDSHCONWAY HOSPITALCMC Cancer Center Infusion - Cancer Infusion394 Singleton Ridge RdConwaySCActive
DSH420049AWChildDSHCONWAY HOSPITALCMC Orthopedics - Socastee6010 Highway 707Myrtle BeachSCActive
DSH420049AXChildDSHCONWAY HOSPITALCMC Wound Care - Hyperbaric300 Singleton Ridge RdConwaySCTerminated
DSH420049BChildDSHCONWAY HOSPITALCMC Digestive Health2376 Cypress CircleConwaySCActive
DSH420049CChildDSHCONWAY HOSPITALCMC PRIMARY CARE-BELL STREET - CMC- Primary Care Bell Street903 BELL STREETCONWAYSCTerminated
DSH420049DChildDSHCONWAY HOSPITALCMC Surgical Associates2361 Cypress CircleConwaySCActive
DSH420049EChildDSHCONWAY HOSPITALCMC Pediatrics - Conway124 Professional Park DriveConwaySCActive
DSH420049FChildDSHCONWAY HOSPITALCMC Ear, Nose and Throat620 Singleton Ridge RoadCONWAYSCActive
DSH420049GChildDSHCONWAY HOSPITALCMC Imaging Center801 Farrar DriveConwaySCActive
DSH420049HChildDSHCONWAY HOSPITALCMC Cardiology2376 Cypress CircleConwaySCActive
DSH420049JChildDSHCONWAY HOSPITALCMC Endocrinology847 Farrar DriveConwaySCActive
DSH420049KChildDSHCONWAY HOSPITALCMC Neurology8024 Myrtle Trace DriveConwaySCActive
DSH420049LChildDSHCONWAY HOSPITALCMC Primary Care - Conway2367-B Cypress CircleConwaySCActive
DSH420049MChildDSHCONWAY HOSPITALCMC Primary Care - Creel Street1301 Creel StreetConwaySCActive
DSH420049NChildDSHCONWAY HOSPITALCMC WOMEN'S HEALTH-TOWNE CENTER - CMC Women's Helath at Towne Centre5010 CAROLINA FOREST BLVDMYRTLE BEACHSCTerminated
DSH420049PChildDSHCONWAY HOSPITALCMC Pediatrics - Carolina Forest4022 Postal WayMyrtle BeachSCActive
DSH420049QChildDSHCONWAY HOSPITALCMC Primary Care - Socastee6010 Highway 707Myrtle BeachSCActive
DSH420049RChildDSHCONWAY HOSPITALCMC Pulmonary and Sleep Medicine2376 Cypress CircleConwaySCActive
DSH420049SChildDSHCONWAY HOSPITALCMC Women's Health - Conway2376 Cypress CircleConwaySCActive
DSH420049TChildDSHCONWAY HOSPITALCMC Primary Care - Towne Center5010 Carolina Forest BoulevardMyrtle BeachSCActive
DSH420049UChildDSHCONWAY HOSPITALCMC Pain Management811 82nd ParkwayMyrtle BeachSCActive
DSH420049VChildDSHCONWAY HOSPITALCMC Primary Care - Surfside Beach1413 Highway 17 NorthSurfside BeachSCActive
DSH420049WChildDSHCONWAY HOSPITALCMC Primary Care - Postal Way4022 Postal WayMyrtle BeachSCActive
DSH420049XChildDSHCONWAY HOSPITALCMC Orthopaedics8004 Myrtle Trace DriveConwaySCActive
DSH420049YChildDSHCONWAY HOSPITALCMC-Primary Care Myrtle Trace8004 Myrtle Trace DriveConwaySCTerminated
DSH420049ZChildDSHCONWAY HOSPITALCMC Primary Care - Highway 904300 Highway 90ConwaySCActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateChange RequestWright, Andrew Director of Pharmacy Conway Hospital Inc dba Conway Medical Center 8433478142Thompson, Brandie Nicole Ambulatory Pharmacy Supervisor Conway Hospital Inc dba Conway Medical Center 843455857012/19/2024 2:53 PM
DetailsLast Recertification DateUpdateRecertification8/18/2023 10:27:18 AM8/21/2024 1:26:57 PM8/21/2024 1:26 PM
DetailsLast Recertification DateUpdateRecertification8/25/2022 8:45:39 AM8/18/2023 10:27:18 AM8/18/2023 10:27 AM
ContactsAuthorizing OfficialUpdateAO Change RequestBarr, Bret Alan CEO Conway Hospital, Inc. 8433478114Williford, Angela Chief Administrative Officer Conway Hospital 84334781661/18/2023 4:35 PM
DetailsLast Recertification DateUpdateRecertification8/25/2021 1:46:12 PM8/25/2022 8:45:39 AM8/25/2022 8:45 AM
ContactsPrimary ContactUpdateGroup Change RequestGAJEWSKI, ROBERT Andrew DIRECTOR OF PHARMACY Conway Hospital, Inc. 8433478120Wright, Andrew Director of Pharmacy Conway Hospital Inc dba Conway Medical Center 84334781424/12/2022 4:21 PM
DetailsLast Recertification DateUpdateRecertification9/14/2020 8:49:42 AM8/25/2021 1:46:12 PM8/25/2021 1:46 PM
Medicaid BillingNPI: NumberInsertChange Request 11341720009/25/2020 1:44 PM
Medicaid BillingNPI: StateInsertChange Request SC9/25/2020 1:44 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/14/2020 8:49 AM
Medicaid BillingMedicaid: NumberInsertRecertification 950178519/14/2020 8:49 AM
Medicaid BillingMedicaid: StateInsertRecertification CO9/14/2020 8:49 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/14/2020 8:49 AM
Medicaid BillingMedicaid: NumberInsertRecertification 0031209709/14/2020 8:49 AM
Medicaid BillingMedicaid: StateInsertRecertification CT9/14/2020 8:49 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/14/2020 8:49 AM
Medicaid BillingMedicaid: NumberInsertRecertification 11341720009/14/2020 8:49 AM
Medicaid BillingMedicaid: StateInsertRecertification MI9/14/2020 8:49 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/14/2020 8:49 AM
Medicaid BillingMedicaid: NumberInsertRecertification 11341720009/14/2020 8:49 AM
Medicaid BillingMedicaid: StateInsertRecertification NC9/14/2020 8:49 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/14/2020 8:49 AM
Medicaid BillingMedicaid: NumberInsertRecertification 04050859/14/2020 8:49 AM
Medicaid BillingMedicaid: StateInsertRecertification OH9/14/2020 8:49 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/14/2020 8:49 AM
Medicaid BillingMedicaid: NumberInsertRecertification 11341720009/14/2020 8:49 AM
Medicaid BillingMedicaid: StateInsertRecertification VA9/14/2020 8:49 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/14/2020 8:49 AM
Medicaid BillingMedicaid: NumberInsertRecertification 04200499/14/2020 8:49 AM
Medicaid BillingMedicaid: StateInsertRecertification VT9/14/2020 8:49 AM
Medicaid BillingNPI: NumberDeleteRecertification1134172000 ( ) 9/14/2020 8:49 AM
Medicaid BillingNPI: NumberInsertRecertification 11341720009/14/2020 8:49 AM
Medicaid BillingNPI: StateInsertRecertification CO9/14/2020 8:49 AM
Medicaid BillingNPI: NumberInsertRecertification 11341720009/14/2020 8:49 AM
Medicaid BillingNPI: StateInsertRecertification CT9/14/2020 8:49 AM
Medicaid BillingNPI: NumberInsertRecertification 11341720009/14/2020 8:49 AM
Medicaid BillingNPI: StateInsertRecertification MI9/14/2020 8:49 AM
Medicaid BillingNPI: NumberInsertRecertification 11341720009/14/2020 8:49 AM
Medicaid BillingNPI: StateInsertRecertification NC9/14/2020 8:49 AM
Medicaid BillingNPI: NumberInsertRecertification 11341720009/14/2020 8:49 AM
Medicaid BillingNPI: StateInsertRecertification OH9/14/2020 8:49 AM
Medicaid BillingNPI: NumberInsertRecertification 11341720009/14/2020 8:49 AM
Medicaid BillingNPI: StateInsertRecertification VA9/14/2020 8:49 AM
Medicaid BillingNPI: NumberInsertRecertification 11341720009/14/2020 8:49 AM
Medicaid BillingNPI: StateInsertRecertification VT9/14/2020 8:49 AM
DetailsLast Recertification DateUpdateRecertification8/27/2019 1:28:31 PM9/14/2020 8:49:42 AM9/14/2020 8:49 AM
DetailsLast Recertification DateUpdateRecertification 8/27/2019 1:28:31 PM8/27/2019 1:28 PM
DetailsStateUpdate ApprovedActive7/1/2019 12:05 AM
AddressesShipping AddressInsertChange Request Conway Medical Center 300 Singleton Ridge Road Conway, SC 295266/19/2019 11:18 AM
ContactsAuthorizing OfficialUpdateReinstatementCLAYTON, PHILIP CEO 8433478114Barr, Bret Alan CEO Conway Hospital, Inc. 84334781144/17/2019 8:16 AM
ContactsSigned ByInsertReinstatement Barr, Bret Alan CEO Conway Hospital, Inc. 84334781144/17/2019 8:16 AM
DetailsEntity NameUpdateReinstatementCONWAY MEDICAL CENTERCONWAY HOSPITAL4/17/2019 8:16 AM
DatesParticipating Approval DateUpdateReinstatement 4/17/2019 8:16:11 AM4/17/2019 8:16 AM
DetailsStateUpdateReinstatementPendingApproved4/17/2019 8:16 AM
DatesSigned By DateUpdateReinstatement5/31/2005 12:00:00 AM4/16/2019 1:39:34 PM4/17/2019 8:16 AM
DatesStart DateUpdateReinstatement 7/1/2019 12:00:00 AM4/17/2019 8:16 AM
DetailsComments PublicInsertReinstatement Participating Start date 7/1/2005, Termination 7/1/2017, Reinstatement 7/1/20194/17/2019 7:25 AM
ContactsPrimary ContactUpdate GAJEWSKI, ROBERT DIRECTOR OF PHARMACY Conway Hospital, Inc. 8433478120GAJEWSKI, ROBERT Andrew DIRECTOR OF PHARMACY Conway Hospital, Inc. 84334781204/10/2019 2:35 PM
Medicaid BillingMedicaid: Is PrimaryInsertReinstatement False4/10/2019 2:10 PM
Medicaid BillingMedicaid: NumberInsertReinstatement 17491804/10/2019 2:10 PM
Medicaid BillingMedicaid: StateInsertReinstatement SC4/10/2019 2:10 PM
Medicaid BillingNPI: NumberInsertReinstatement 11341720004/10/2019 2:10 PM
ContactsPrimary ContactUpdateReinstatementGAJEWSKI, ROBERT DIRECTOR OF PHARMACY 8433478120GAJEWSKI, ROBERT DIRECTOR OF PHARMACY Conway Hospital, Inc. 84334781204/10/2019 2:10 PM
DetailsLast Recertification DateUpdateReinstatement9/1/2016 12:00:00 AM 4/10/2019 2:10 PM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement1/1/2017 12:00:00 AM 4/10/2019 2:10 PM
DatesParticipating Approval DateUpdateReinstatement6/17/2005 12:00:00 AM 4/10/2019 2:10 PM
DetailsStateUpdateReinstatementTerminatedPending4/10/2019 2:10 PM
DatesRegistration DateUpdateReinstatement7/1/2005 12:00:00 AM4/10/2019 2:10:32 PM4/10/2019 2:10 PM
DatesStart DateUpdateReinstatement7/1/2005 12:00:00 AM 4/10/2019 2:10 PM
TerminationsTermination CommentsUpdateReinstatementConway Medical Center (CMC; 340B ID DSH420049) would like to submit a termination request to update the HRSA 340B database to reflect its terminated status with an effective date of January 1, 2017. None of the four termination reasons provided on this change request form apply to CMC. Per Apexus’ instructions, CMC has selected “Site Closure” as the reason for termination based on the understanding that HRSA will subsequently attach the correct termination code. The reason for CMC’s termination  4/10/2019 2:10 PM
TerminationsTermination DateUpdateReinstatement7/1/2017 12:00:00 AM 4/10/2019 2:10 PM
TerminationsTermination Effective DateUpdateReinstatement1/1/2017 12:00:00 AM 4/10/2019 2:10 PM
TerminationsTermination ReasonUpdateReinstatementSite closure 4/10/2019 2:10 PM
AddressesMain AddressInsert   300 SINGLETON RIDGE ROAD CONWAY, SC 295266/12/2017 2:28 PM
ContactsAuthorizing OfficialInsert  CLAYTON, PHILIP CEO 84334781146/12/2017 2:28 PM
ContactsPrimary ContactInsert  GAJEWSKI, ROBERT DIRECTOR OF PHARMACY 84334781206/12/2017 2:28 PM
DatesLast Date That 340B Drugs PurchasedUpdate  1/1/2017 12:00:00 AM6/12/2017 2:27 PM
DetailsStateUpdate ActiveTerminated6/12/2017 2:27 PM
TerminationsTermination CommentsUpdate  Conway Medical Center (CMC; 340B ID DSH420049) would like to submit a termination request to update the HRSA 340B database to reflect its terminated status with an effective date of January 1, 2017. None of the four termination reasons provided on this change request form apply to CMC. Per Apexus’ instructions, CMC has selected “Site Closure” as the reason for termination based on the understanding that HRSA will subsequently attach the correct termination code. The reason for CMC’s termination 6/12/2017 2:27 PM
TerminationsTermination DateUpdate  7/1/2017 12:00:00 AM6/12/2017 2:27 PM
TerminationsTermination Effective DateUpdate  1/1/2017 12:00:00 AM6/12/2017 2:27 PM
TerminationsTermination ReasonUpdate  Site closure6/12/2017 2:27 PM
DetailsLast Recertification DateUpdate 8/27/2015 12:00:00 AM9/1/2016 12:00:00 AM9/1/2016 9:18 AM
DetailsLast Recertification DateUpdate 9/3/2014 12:00:00 AM8/27/2015 12:00:00 AM8/27/2015 10:07 AM
DetailsLast Recertification DateUpdate 9/9/2013 12:00:00 AM9/3/2014 12:00:00 AM9/3/2014 1:47 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/9/2013 12:00:00 AM9/9/2013 10:24 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/18/2012 12:27 PM
DetailsLast Recertification DateInsert   12/12/2006 2:27 PM
DetailsGrant NumberInsert   12/12/2006 2:27 PM
Details340B IDInsert  DSH42004912/12/2006 2:27 PM
DetailsIs Authorizing Official EHB DataInsert   12/12/2006 2:27 PM
DatesLast Date That 340B Drugs PurchasedInsert   12/12/2006 2:27 PM
DetailsMedicare Provider NumberInsert  42004912/12/2006 2:27 PM
DetailsEntity NameInsert  CONWAY MEDICAL CENTER12/12/2006 2:27 PM
DetailsProgram CodeInsert  DSH12/12/2006 2:27 PM
DetailsEntity SubnameInsert   12/12/2006 2:27 PM
DatesParticipating Approval DateInsert  6/17/2005 12:00:00 AM12/12/2006 2:27 PM
DetailsStateInsert  Active12/12/2006 2:27 PM
DatesRegistration DateInsert  7/1/2005 12:00:00 AM12/12/2006 2:27 PM
DatesSigned By DateInsert  5/31/2005 12:00:00 AM12/12/2006 2:27 PM
DatesStart DateInsert  7/1/2005 12:00:00 AM12/12/2006 2:27 PM
TerminationsTermination CommentsInsert   12/12/2006 2:27 PM
TerminationsTermination DateInsert   12/12/2006 2:27 PM
TerminationsTermination Effective DateInsert   12/12/2006 2:27 PM
TerminationsTermination ReasonInsert   12/12/2006 2:27 PM