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SOUTH CAROLINA CVS PHARMACY, L.L.C.
RWII29204 Palmetto AIDS Life Support Services, Inc.
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Covered Entity Details
Entity Name
Palmetto AIDS Life Support Services, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII29204
Entity Address
2638 Two Notch Road
Suite 108
Columbia, SC 29204-1454
Grant Number
X07HA00038
Participating Start Date
10/1/2016
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05596
4627 NORTH MAIN STREET
COLUMBIA, SC 29203
Pharmacy Comments
Contract Details
Approval Date
10/3/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carmen H. Julious, CEO
(803) 779-7257
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/3/2018
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