Contract Pharmacy Details

SOUTH CAROLINA CVS PHARMACY, L.L.C.
CH047060 LITTLE RIVER MEDICAL CENTER, INC.

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

SOUTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01140
101 FETLOCK DR.
MYRTLE BEACH, SC 29588

Pharmacy Comments

Contract Details

Approval Date

7/2/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/23/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

PAMELA R. DAVIS, CEO
(843) 663-8001

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/2/2019

340B Drug Pricing Program Database