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SOUTH CAROLINA CVS PHARMACY, L.L.C.
RWII29601A AID Upstate
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Covered Entity Details
Entity Name
AID Upstate
Subdivision Name
Type
Ryan White Part B
340B ID
RWII29601A
Entity Address
118 Montgomery Drive
Anderson, SC 29621
Grant Number
X07HA00038
Participating Start Date
4/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03541
109 HIGHWAY 28 BY-PASS
ANDERSON, SC 29624
Pharmacy Comments
Contract Details
Approval Date
10/18/2019
Contract Begin Date
1/1/2020
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
Roshan McDaniel, SC ADAP Director
(803) 898-0703
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/18/2019
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