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SOUTH CAROLINA CVS PHARMACY, L.L.C.
STD292041 Palmetto AIDS Life Support Services, Inc.
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Covered Entity Details
Entity Name
Palmetto AIDS Life Support Services, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD292041
Entity Address
2638 Two Notch Road
Suite 108
Columbia, SC 29204
Grant Number
NH25PS004378
Participating Start Date
10/1/2016
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04114
3700 TWO NOTCH ROAD
COLUMBIA, SC 29204
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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