Covered Entity Details

CH04111P FETTER HEALTH CARE NETWORK, INC. (Terminated) - information as of 4/28/2025 12:42:35 AM

Main Details

Name

FETTER HEALTH CARE NETWORK, INC.

Subdivision Name

Berkeley Community Mental Health

Type

HRSA-Funded Health Center

Site ID

BPS-H80-024847

340B ID

CH04111P

Grant Number

H80CS09088

Additional Details

Current Program Status

Terminated

Registration Date

2/22/2019

Participating Start Date

4/1/2019

Participating Approval Date

3/1/2019

Last Recertification Date

1/30/2023

Termination Date
Termination Reason

4/1/2024
Other

Contacts

Authorizing Official

Fetter Health Care Network
Aretha Jones, CEO
(843) 722-4112 Ext: 3004

Primary Contact

Fetter Health Care Network, Inc
Sharvette Slaughter, MD
(843) 722-4112 Ext: 4115

Addresses

Street Address

403 Stony Landing Rd
Moncks Corner, SC 29461-3967

Billing Address
Same as Street Address

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	FQC225	1255800603

Shipping Addresses

Same as Street Address

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
CH041110	Active	BPS-H80-002798	FETTER HEALTHCARE NETWORK INC.	FRANKLIN C FETTER FAMILY HEALTH CENTER	51 Nassau St	Charleston	SC
CH04111A	Active	BPS-H80-014185	FETTER HEALTH CARE NETWORK INC	FHCN-JOHNS ISLAND SITE	3627 Maybank Hwy	Johns Island	SC
CH04111B	Active	BPS-H80-008450	FETTER HEALTH CARE NETWORK INC	FCFFHC-WALTERBORO SITE	302 MEDICAL PARK DRIVE	WALTERBORO	SC
CH04111C1	Active	BPS-H80-011207	FETTER HEALTH CARE NETWORK INC	FHCN-HOLLYWOOD SITE	5225 HIGHWAY 165	HOLLYWOOD	SC
CH04111D	Active	BPS-H80-015188	FETTER HEALTH CARE NETWORK INC	Elijah Wright Health Center	1681 Old Highway 6	Cross	SC
CH04111F	Active	BPS-H80-022065	FETTER HEALTH CARE NETWORK INC	TJ BELL FAMILY HEALTH CENTER	130 Varnfield Drive	Summerville	SC
CH04111G	Terminated	BPS-H80-002319	FRANKLIN C FETTER FAMILY HEALTH CENTER INC	FRANKLIN C FETTER PEDIATRICS	300 E Main St	Moncks Corner	SC
CH04111H	Active	BPS-H80-002514	FETTER HEALTH CARE NETWORK INC	ENTERPRISE PEDIATRICS	2047 Comstock Ave	North Charleston	SC
CH04111J	Terminated	BPS-H80-015180	FRANKLIN C FETTER FAMILY HEALTH CENTER INC	Community Dental Centers	700 RUTLEDGE AVE	CHARLESTON	SC
CH04111K	Active	BPS-H80-010849	FETTER HEALTH CARE NETWORK, INC.	CHARLESTON MENTAL HEALTH	2100 CHARLIE HALL BLVD	CHARLESTON	SC
CH04111L	Active	BPS-H80-022268	FETTER HEALTH CARE NETWORK, INC.	Fetter Mobile Dental Vehicle	51 Nassau St.	Charleston	SC
CH04111M	Active	BPS-H80-020782	FETTER HEALTH CARE NETWORK, INC.	One80 Place	35 Walnut Street	Charleston	SC
CH04111N	Active	BPS-H80-022064	FETTER HEALTH CARE NETWORK, INC.	RD Gibbs Family Health Center	106 West Main Street	Moncks Corner	SC
CH04111P	Terminated	BPS-H80-024847	FETTER HEALTH CARE NETWORK, INC.	Berkeley Community Mental Health	403 Stony Landing Rd	Moncks Corner	SC
CH04111Q	Active	BPS-H80-030917	FETTER HEALTH CARE NETWORK, INC.	Fetter Mobile Outreach Vehicle	51 Nassau St	Charleston	SC
CH04111R	Active	BPS-H80-031930	FETTER HEALTH CARE NETWORK, INC.	Fetter Mobile Medical Unit 2	51 Nassau St	Charleston	SC
CH04111S	Active	BPS-H80-034233	FETTER HEALTH CARE NETWORK, INC.	Dorchester Family Health Center	679 Orangeburg Rd UNIT F	Summerville	SC
CH04111T	Active	BPS-H80-034020	FETTER HEALTH CARE NETWORK, INC.	Morningside Middle School	1999 Singley St	North Charleston	SC
CH04111U	Active	BPS-H80-019147	FETTER HEALTH CARE NETWORK, INC.	Baptist Hill Middle High School	5117 Baptist Hill Rd	Hollywood	SC
CH04111V	Active	BPS-H80-035296	FETTER HEALTH CARE NETWORK, INC.	Thaddeus J Bell, MD Family Health Center Annex	120 Varnfield Dr STE B	Summerville	SC
CH04111W	Active	BPS-H80-024844	FETTER HEALTH CARE NETWORK, INC.	Jerry Zucker Middle School of Science	6401 Dorchester Rd	North Charleston	SC

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH041110	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	01/01/2019
CH041110	AVELLA OF COLUMBUS	4830 KNIGHTSBRIDGE BLVD STE C		COLUMBUS	OH	43214-2300	01/01/2019	07/01/2020
CH041110	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	01/01/2019	07/01/2020
CH041110	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH041110	BI-LO PHARMACY #5284	110 SOUTH HWY 52, SUITE B		MONCKS CORNER	SC	29461	01/01/2019	06/03/2020
CH041110	BI-LO PHARMACY #5409	1200 SAM RITTENBERG BLVD	SUITE A	CHARLESTON	SC	29407	01/01/2019	06/03/2020
CH041110	BI-LO PHARMACY #5707	550 ROBERTSON BLVD		WALTERBORO	SC	29488	01/01/2019	06/03/2020
CH041110	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/01/2020
CH041110	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/01/2020
CH041110	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	07/01/2018
CH041110	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	04/01/2020
CH041110	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	07/01/2018
CH041110	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	07/01/2023
CH041110	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2023
CH041110	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	07/01/2018
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07695	6323 SAVANNAH HWY, UNIT D	RAVENEL	SC	29470	01/01/2018
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03870	4400 DORCHESTER RD	CHARLESTON	SC	29405	10/01/2021
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03977	1506 EAST MONTAGUE AVE	NORTH CHARLESTON	SC	29405	10/01/2021
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03564	1015 KING ST.	CHARLESTON	SC	29403	10/01/2021
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05386	8523 OLD STATE ROAD, POB 730	HOLLY HILL	SC	29059	10/01/2021
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03585	555 ROBERTSON BLVD.	WALTERBORO	SC	29488	10/01/2021
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05555	8910 OLD NUMBER SIX HWY	SANTEE	SC	29142	10/01/2023
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05580	1941 N. MAIN ST.	SUMMERVILLE	SC	29486	10/01/2023
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03834	100 REMBERT DENNIS BLVD	MONCKS CORNER	SC	29461	10/01/2023
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04204	301 N MAIN ST	SUMMERVILLE	SC	29483	10/01/2023
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03113	1602 CENTRAL AVE.	SUMMERVILLE	SC	29483	10/01/2023
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03801	2152 SAVANNAH HWY.	CHARLESTON	SC	29414	10/01/2023
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07568	1055 RED BANK ROAD	GOOSE CREEK	SC	29445	10/01/2023
CH041110	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00528	3575 MAYBANK HIGHWAY SUITE K	JOHNS ISLAND	SC	29455	10/01/2023
CH041110	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2018
CH041110	WAL-MART PHARMACY 10-0616	2795 NORTH RD		ORANGEBURG	SC	29118	10/01/2018
CH041110	WAL-MART PHARMACY 10-1037	1317 N MAIN STREET		SUMMERVILLE	SC	29483	10/01/2016
CH041110	WAL-MART PHARMACY 10-1146	511 NO. HWY 52		MONCKS CORNER	SC	29461	10/01/2018
CH041110	WAL-MART PHARMACY 10-1358	2110 BELLS HIGHWAY		WALTERBORO	SC	29488	10/01/2016
CH041110	WAL-MART PHARMACY 10-1359	7400 RIVERS AVENUE		NORTH CHARLESTON	SC	29406	10/01/2016
CH041110	WAL-MART PHARMACY 10-1748	3951 W ASHLEY CIRCLE		CHARLESTON	SC	29414	10/01/2016
CH041110	WAL-MART PHARMACY 10-2928	605 ST. JAMES AVENUE		GOOSE CREEK	SC	29445	10/01/2018
CH041110	WAL-MART PHARMACY 10-3367	4920 CENTRE POINTE DRIVE		NORTH CHARLESTON	SC	29418	10/01/2016
CH041110	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2018
CH041110	WALGREEN CO.	DBA: WALGREENS # 06076	8395 DORCHESTER RD	NORTH CHARLESTON	SC	29418	10/01/2013
CH041110	WALGREEN CO.	DBA: WALGREENS #15630	907 FOLLY RD	CHARLESTON	SC	29412-3919	10/01/2013
CH041110	WALGREEN CO.	DBA: WALGREENS # 09284	1326 N JEFFERIES BLVD	WALTERBORO	SC	29488-2733	10/01/2013
CH041110	WALGREEN CO.	DBA: WALGREENS # 10257	395 N HWY 52	MONCKS CORNER	SC	29461-3919	10/01/2013
CH041110	WALGREEN CO.	DBA: WALGREENS #11270	1861 REMOUNT RD.	NORTH CHARLESTON	SC	29406-3288	10/01/2013
CH041110	WALGREEN CO.	DBA: WALGREENS #12782	1925 ASHLEY RIVER RD.	CHARLESTON	SC	29407	10/01/2013
CH041110	WALGREEN CO.	DBA: WALGREENS #15024	7501 RIVERS AVENUE	NORTH CHARLESTON	SC	29406-4662	10/01/2013
CH041110	WALGREEN CO.	DBA: WALGREENS # 01072	1120 N MAIN STREET	SUMMERVILLE	SC	29483-7326	04/01/2015
CH041110	WALGREEN CO.	DBA: WALGREENS # 06073	54 OLD TROLLEY ROAD	SUMMERVILLE	SC	29485	01/01/2017
CH041110	WALGREEN CO.	DBA: WALGREENS # 07702	9998 DORCHESTER RD.	SUMMERVILLE	SC	29485-8526	01/01/2017
CH041110	WALGREEN CO.	DBA: WALGREENS #09738	1584 CENTRAL AVE.	SUMMERVILLE	SC	29483-5528	01/01/2017
CH041110	WALGREEN CO.	DBA WALGREENS #15512	380 KING ST.	CHARLESTON	SC	29401	01/01/2017
CH041110	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21191	200 RUTLEDGE AVE	CHARLESTON	SC	29403-5848	04/01/2020
CH041110	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	10/01/2023
CH041110	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	State	Update		To Be Terminated	Terminated	4/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		1/29/2024 12:00:00 AM	2/5/2024 7:21 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/5/2024 7:21 AM
Terminations	Termination Comments	Update	Recertification		Site removed from scope of work due to not being productive.	2/5/2024 7:21 AM
Terminations	Termination Date	Update	Recertification		4/1/2024 12:00:00 AM	2/5/2024 7:21 AM
Terminations	Termination Effective Date	Update	Recertification		1/29/2024 12:00:00 AM	2/5/2024 7:21 AM
Terminations	Termination Reason	Update	Recertification		Other	2/5/2024 7:21 AM
Contacts	Primary Contact	Update	Group Change Request	Smith, Mary Stacey Pharmacy Program Manager Fetter Healthcare Network 8434945534-3012	Slaughter, Sharvette MD Fetter Health Care Network, Inc 8437224112-4115	3/3/2023 9:38 AM
Details	Last Recertification Date	Update	Recertification	2/4/2022 7:26:08 AM	1/30/2023 3:50:31 PM	1/30/2023 3:50 PM
Contacts	Primary Contact	Update	Recertification	Catravas, Joanna Elaine Pharmacy Programs Manager Fetter Health Care Network 8439981776	Smith, Mary Stacey Pharmacy Program Manager Fetter Healthcare Network 8434945534-3012	2/4/2022 7:26 AM
Details	Last Recertification Date	Update	Recertification	2/23/2021 7:42:36 PM	2/4/2022 7:26:08 AM	2/4/2022 7:26 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	2/23/2021 7:42 PM
Details	Last Recertification Date	Update	Recertification	2/11/2020 1:21:22 PM	2/23/2021 7:42:36 PM	2/23/2021 7:42 PM
Contacts	Primary Contact	Update	Recertification	Brooker, Deborah Stivender Pharmacy Coordinator Fetter Health Care Network 8437205655	Catravas, Joanna Elaine Pharmacy Programs Manager Fetter Health Care Network 8439981776	2/11/2020 1:21 PM
Details	Last Recertification Date	Update	Recertification		2/11/2020 1:21:22 PM	2/11/2020 1:21 PM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2019 11:22 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		FQC225	3/15/2019 11:22 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	3/15/2019 11:22 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1255800603	3/15/2019 11:22 AM
Contacts	Signed By	Insert	New Registration		Jones, Aretha CEO Fetter Health Care Network 8437224112-3004	3/1/2019 7:51 AM
Details	340B ID	Update	New Registration		CH04111P	3/1/2019 7:51 AM
Dates	Participating Approval Date	Update	New Registration		3/1/2019 7:51:42 AM	3/1/2019 7:51 AM
Details	State	Update	New Registration	Pending	Approved	3/1/2019 7:51 AM
Dates	Signed By Date	Update	New Registration		2/22/2019 4:01:28 PM	3/1/2019 7:51 AM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	3/1/2019 7:51 AM
Addresses	Main Address	Insert	New Registration		403 Stony Landing Rd Moncks Corner, SC 29461-3967	2/22/2019 4:01 PM
Contacts	Authorizing Official	Insert	New Registration		Jones, Aretha CEO Fetter Health Care Network 8437224112-3004	2/22/2019 4:01 PM
Contacts	Primary Contact	Insert	New Registration		Brooker, Deborah Stivender Pharmacy Coordinator Fetter Health Care Network 8437205655	2/22/2019 4:01 PM
Details	Last Recertification Date	Insert	New Registration			2/22/2019 4:01 PM
Details	Grant Number	Insert	New Registration		H80CS09088	2/22/2019 4:01 PM
Details	340B ID	Insert	New Registration			2/22/2019 4:01 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			2/22/2019 4:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			2/22/2019 4:01 PM
Details	Medicare Provider Number	Insert	New Registration			2/22/2019 4:01 PM
Details	Entity Name	Insert	New Registration		FETTER HEALTH CARE NETWORK, INC.	2/22/2019 4:01 PM
Details	Program Code	Insert	New Registration		CH	2/22/2019 4:01 PM
Details	Entity Subname	Insert	New Registration		Berkeley Community Mental Health	2/22/2019 4:01 PM
Dates	Participating Approval Date	Insert	New Registration			2/22/2019 4:01 PM
Details	State	Insert	New Registration		Pending	2/22/2019 4:01 PM
Dates	Registration Date	Insert	New Registration		2/22/2019 4:01:26 PM	2/22/2019 4:01 PM
Dates	Signed By Date	Insert	New Registration			2/22/2019 4:01 PM
Dates	Start Date	Insert	New Registration			2/22/2019 4:01 PM
Terminations	Termination Comments	Insert	New Registration			2/22/2019 4:01 PM
Terminations	Termination Date	Insert	New Registration			2/22/2019 4:01 PM
Terminations	Termination Effective Date	Insert	New Registration			2/22/2019 4:01 PM
Terminations	Termination Reason	Insert	New Registration			2/22/2019 4:01 PM

340B Drug Pricing Program Database