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SOUTH CAROLINA CVS PHARMACY, L.L.C.
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
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05515
601 HWY 17 NORTH
SURFSIDE BEACH, SC 29575
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
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
10/11/2019
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