Covered Entity Details

CH042359D Tandem Health SC (Active) - information as of 6/6/2025 12:39:58 PM

Main Details

Name

Tandem Health SC

Subdivision Name

Tandem Health

Type

HRSA-Funded Health Center

Site ID

BPS-H80-024753

340B ID

CH042359D

Grant Number

H80CS00868

Additional Details

Current Program Status

Active

Registration Date

10/25/2018

Participating Start Date

10/26/2018

Participating Approval Date

10/26/2018

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Tandem Health SC
Annie Brown, CEO
(803) 774-4500 Ext: 545

Primary Contact

Tandem Health SC
Nick Tomlinson, Director of Pharmacy
(803) 774-4631

Addresses

Street Address

370 South Pike West
Sumter, SC 29150

Billing Address

Tandem Health SC
Post Office Box 250
Sumter, SC 29151

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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	FQC221,796147,7Z1016	1003371386,1114114501,1740641919

Shipping Addresses

Shipping Address 1

Tandem Health SC
370 South Pike West
**PHARMACY *DELIVERY* ADDRESS is 368 South Pike West**
Sumter, SC 29150

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH0423590	Active	BPS-H80-005578	Tandem Health SC	Tandem Health	1278 North Lafayette Drive	Sumter	SC
CH042359A	Active	BPS-H80-003139	Tandem Health SC	Tandem Health	25 E Clark St	Pinewood	SC
CH042359B	Active	BPS-H80-013422	Tandem Health SC	Tandem Health	319 N Main St	Sumter	SC
CH042359C	Terminated	BPS-H80-020999	Tandem Health SC	Tandem Health	1105 North Lafayette Drive, Suite B	Sumter	SC
CH042359D	Active	BPS-H80-024753	Tandem Health SC	Tandem Health	370 South Pike West	Sumter	SC
CH042359E	Active	BPS-H80-033768	TANDEM HEALTH SC	Tandem Health Dental	12 Barnette Dr	Sumter	SC
CH042359F	Active	BPS-H80-037696	TANDEM HEALTH SC	Rafting Creek Elementary School	4100 Highway 261 N	Rembert	SC
CH042359G	Active	BPS-H80-037668	TANDEM HEALTH SC	Manchester Elementary School	200 W Clark St	Pinewood	SC
CH042359H	Active	BPS-H80-038385	TANDEM HEALTH SC	Tandem Health	425 N Salem Ave	Sumter	SC

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH0423590	ADVANCED PHARMACY, LLC	ADVANCED PHARMACY	350 FEASTER ROAD SUITE D	GREENVILLE	SC	29615-6176	01/01/2016	05/01/2018
CH042359A	ADVANCED PHARMACY, LLC	ADVANCED PHARMACY	350 FEASTER ROAD SUITE D	GREENVILLE	SC	29615-6176	01/01/2016	05/01/2018
CH042359B	ADVANCED PHARMACY, LLC	ADVANCED PHARMACY	350 FEASTER ROAD SUITE D	GREENVILLE	SC	29615-6176	01/01/2016	05/01/2018
CH0423590	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	10/01/2014
CH042359A	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	01/01/2015	12/31/2018
CH042359B	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	01/01/2015	12/31/2018
CH0423590	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2018
CH0423590	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	10/01/2024
CH0423590	AMAZON PHARMACY #008	408 TECHNOLOGY PARKWAY	BUILDING B, STE 101	COLLEGE STATION	TX	77845	10/01/2024
CH0423590	AMAZON PHARMACY #009	7469 KINGSPOINTE PKWY STE 400		ORLANDO	FL	32819	10/01/2024
CH0423590	AMAZON PHARMACY #010	1331 E 6TH ST		CORONA	CA	92879	10/01/2024
CH0423590	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	10/01/2016	10/01/2020
CH0423590	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	10/01/2016	09/30/2020
CH0423590	AVELLA OF ORLANDO	100 TECHNOLOGY PARK STE 155		LAKE MARY	FL	32746-6205	10/01/2016	09/30/2020
CH0423590	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	01/01/2024
CH0423590	AVITA PHARMACY 1058	MEDEXPRESS PHARMACY, LTD. DBA AVITA PHAR	1431 W. INNES ST.	SALISBURY	NC	28144	01/01/2024
CH0423590	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	04/01/2019
CH0423590	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	07/01/2020
CH0423590	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/01/2020
CH0423590	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/01/2020
CH0423590	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2025
CH0423590	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	01/01/2018	04/01/2020
CH0423590	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	01/01/2020
CH0423590	IC PHARMACY LLC	AMAZON PHARMACY #004	34 35TH STREET STE 4BSW, UNIT 28	BROOKLYN	NY	11232	10/01/2024
CH0423590	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	01/01/2024
CH0423590	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2018
CH0423590	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	10/01/2013	01/01/2016
CH042359A	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	01/01/2015	01/01/2016
CH042359B	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	01/01/2015	01/01/2016
CH0423590	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/01/2022
CH0423590	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/01/2022
CH0423590	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/07/2020
CH0423590	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/01/2022
CH0423590	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	04/01/2022
CH0423590	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018
CH0423590	PILLPACK LLC	AMAZON PHARMACY #005	20416 72ND AVE S	KENT	WA	98032-2319	10/01/2024
CH0423590	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04184	1080 ALICE DRIVE	SUMTER	SC	29150	07/01/2018
CH0423590	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02251	41 EAST CALHOUN STREET	SUMTER	SC	29150	07/01/2018
CH0423590	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03597	119 WEST BOYCE STREET	MANNING	SC	29102	04/01/2019
CH0423590	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2020
CH0423590	WAL-MART PHARMACY 10-0511	1283 BROAD STREET		SUMTER	SC	29150	01/01/2020	12/31/2019
CH0423590	WAL-MART PHARMACY 10-0511	1283 BROAD STREET		SUMTER	SC	29150	07/01/2020
CH0423590	WAL-MART PHARMACY 10-5383	615 BULTMAN DRIVE		SUMTER	SC	29150	01/01/2020	12/31/2019
CH0423590	WAL-MART PHARMACY 10-5383	615 BULTMAN DRIVE		SUMTER	SC	29150	07/01/2020
CH0423590	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2020
CH0423590	WALGREEN CO.	DBA: WALGREENS # 06074	1000 BROAD ST	SUMTER	SC	29150	01/01/2017
CH0423590	WALGREEN CO.	DBA: WALGREENS # 09276	1990 MCCRAYS MILL RD.	SUMTER	SC	29150-6185	01/01/2017
CH0423590	WALGREEN CO.	DBA: WALGREENS #11724	201 N. LAFAYETTE DR.	SUMTER	SC	29150-4341	01/01/2017
CH0423590	WALGREEN CO.	WALGREENS #16396	805 PAMPLICO HWY. SUITE B-130	FLORENCE	SC	29505	01/01/2018	10/12/2017
CH0423590	WALGREEN CO.	WALGREENS #16396	805 PAMPLICO HWY. SUITE B-130	FLORENCE	SC	29505	04/01/2018	06/08/2022
CH0423590	WALGREEN CO.	WALGREENS #16396	805 PAMPLICO HWY. SUITE B-130	FLORENCE	SC	29505	04/01/2018	01/28/2019
CH0423590	WALMART PHARMACY 10-0377	343 PINEWOOD ROAD		SUMTER	SC	29150	01/01/2020	12/31/2019
CH0423590	WALMART PHARMACY 10-0377	343 PINEWOOD ROAD		SUMTER	SC	29150	07/01/2020
CH0423590	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 6:04:42 PM	2/12/2025 11:03:53 AM	2/12/2025 11:03 AM
Details	Last Recertification Date	Update	Recertification	2/1/2023 5:17:41 PM	2/1/2024 6:04:42 PM	2/1/2024 6:04 PM
Details	Last Recertification Date	Update	Recertification	2/8/2022 10:43:52 AM	2/1/2023 5:17:41 PM	2/1/2023 5:17 PM
Details	Last Recertification Date	Update	Recertification	2/10/2021 12:15:40 PM	2/8/2022 10:43:52 AM	2/8/2022 10:43 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114114501 ( )		2/10/2021 12:15 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1003371386 ( )		2/10/2021 12:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1003371386	2/10/2021 12:15 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	2/10/2021 12:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114114501	2/10/2021 12:15 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	2/10/2021 12:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740641919	2/10/2021 12:15 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	2/10/2021 12:15 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1740641919 ( )		2/10/2021 12:15 PM
Details	Last Recertification Date	Update	Recertification	1/27/2020 2:54:32 PM	2/10/2021 12:15:40 PM	2/10/2021 12:15 PM
Details	Last Recertification Date	Update	Recertification	2/12/2019 2:54:38 PM	1/27/2020 2:54:32 PM	1/27/2020 2:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2019 2:21 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		FQC221	5/30/2019 2:21 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	5/30/2019 2:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2019 2:21 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		796147	5/30/2019 2:21 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	5/30/2019 2:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/30/2019 2:21 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7Z1016	5/30/2019 2:21 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	5/30/2019 2:21 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1114114501	5/30/2019 2:21 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1003371386	5/30/2019 2:21 PM
Details	Last Recertification Date	Update	Recertification		2/12/2019 2:54:38 PM	2/12/2019 2:54 PM
Addresses	Main Address	Update	Change Request	370 South Pike West BLDG Sumter, SC 29150	370 South Pike West Sumter, SC 29150	1/18/2019 10:09 AM
Addresses	Billing Address	Update	Change Request	Sumter Family Health Center Post Office Box 250 Sumter, SC 29151	Tandem Health SC Post Office Box 250 Sumter, SC 29151	1/18/2019 10:09 AM
Addresses	Shipping Address	Insert	Change Request		Tandem Health SC 370 South Pike West *PHARMACY DELIVERY* ADDRESS is 368 South Pike West** Sumter, SC 29150	1/18/2019 10:09 AM
Contacts	Primary Contact	Update	Change Request	Tomlinson, Nick Director of Pharmacy Sumter Family Health Center 8037744631	Tomlinson, Nick Director of Pharmacy Tandem Health SC 8037744631	1/18/2019 10:09 AM
Contacts	Authorizing Official	Update	Change Request	BROWN, ANNIE CEO Sumter Family Health Center 8037744545	Brown, Annie CEO Tandem Health SC 8037744500-545	1/18/2019 10:09 AM
Details	Entity Name	Update	Change Request	Sumter Family Health Center	Tandem Health SC	1/18/2019 10:09 AM
Details	Entity Subname	Update	Change Request	Pike West	Tandem Health	1/18/2019 10:09 AM
Details	State	Update	OPA Edit	Approved	Active	10/26/2018 7:30 AM
Dates	Start Date	Update	OPA Edit	1/1/2019 12:00:00 AM	10/26/2018 12:00:00 AM	10/26/2018 7:30 AM
Contacts	Signed By	Insert	New Registration		BROWN, ANNIE CEO Sumter Family Health Center 8037744545	10/26/2018 7:28 AM
Details	340B ID	Update	New Registration		CH042359D	10/26/2018 7:28 AM
Dates	Participating Approval Date	Update	New Registration		10/26/2018 7:28:43 AM	10/26/2018 7:28 AM
Details	State	Update	New Registration	Pending	Approved	10/26/2018 7:28 AM
Dates	Signed By Date	Update	New Registration		10/25/2018 2:15:08 PM	10/26/2018 7:28 AM
Dates	Start Date	Update	New Registration		1/1/2019 12:00:00 AM	10/26/2018 7:28 AM
Addresses	Main Address	Insert	New Registration		370 South Pike West BLDG Sumter, SC 29150	10/25/2018 2:15 PM
Addresses	Billing Address	Insert	New Registration		Sumter Family Health Center Post Office Box 250 Sumter, SC 29151	10/25/2018 2:15 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1740641919	10/25/2018 2:15 PM
Contacts	Primary Contact	Insert	New Registration		Tomlinson, Nick Director of Pharmacy Sumter Family Health Center 8037744631	10/25/2018 2:15 PM
Contacts	Authorizing Official	Insert	New Registration		BROWN, ANNIE CEO Sumter Family Health Center 8037744545	10/25/2018 2:15 PM
Details	Last Recertification Date	Insert	New Registration			10/25/2018 2:15 PM
Details	Grant Number	Insert	New Registration		H80CS00868	10/25/2018 2:15 PM
Details	340B ID	Insert	New Registration			10/25/2018 2:15 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/25/2018 2:15 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/25/2018 2:15 PM
Details	Medicare Provider Number	Insert	New Registration			10/25/2018 2:15 PM
Details	Entity Name	Insert	New Registration		Sumter Family Health Center	10/25/2018 2:15 PM
Details	Program Code	Insert	New Registration		CH	10/25/2018 2:15 PM
Details	Entity Subname	Insert	New Registration		Pike West	10/25/2018 2:15 PM
Dates	Participating Approval Date	Insert	New Registration			10/25/2018 2:15 PM
Details	State	Insert	New Registration		Pending	10/25/2018 2:15 PM
Dates	Registration Date	Insert	New Registration		10/25/2018 2:15:06 PM	10/25/2018 2:15 PM
Dates	Signed By Date	Insert	New Registration			10/25/2018 2:15 PM
Dates	Start Date	Insert	New Registration			10/25/2018 2:15 PM
Terminations	Termination Comments	Insert	New Registration			10/25/2018 2:15 PM
Terminations	Termination Date	Insert	New Registration			10/25/2018 2:15 PM
Terminations	Termination Effective Date	Insert	New Registration			10/25/2018 2:15 PM
Terminations	Termination Reason	Insert	New Registration			10/25/2018 2:15 PM

340B Drug Pricing Program Database