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WALGREEN CO.
CH047060 LITTLE RIVER MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
LITTLE RIVER MEDICAL CENTER, INC.
Subdivision Name
LITTLE RIVER MEDICAL CENTER, INC.: MAIN SITE
Type
HRSA-Funded Health Center
340B ID
CH047060
Entity Address
4303 Live Oak Dr.
Little River, SC 29566
Grant Number
H80CS00700
Participating Start Date
12/1/1992
Last Recertification Date
2/16/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17460
1905 HIGHWAY 544
CONWAY, SC 29526
Pharmacy Comments
Contract Details
Approval Date
7/3/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PAMELA R. DAVIS, CEO
(843) 663-8001
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/3/2018
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