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SOUTH CAROLINA CVS PHARMACY, L.L.C.
STD29621 AID UPSTATE
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Covered Entity Details
Entity Name
AID UPSTATE
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD29621
Entity Address
118 MONTGOMERY DRIVE
ANDERSON, SC 29621
Grant Number
NH25PS005150
Participating Start Date
4/1/2017
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 3203
35 SOUTH MAIN STREET
GREENVILLE, SC 29601
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/21/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
B ANDREW HALL, CEO
(864) 250-0607 Ext: 6208
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2019
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