Contract Pharmacy Details

KJS PHARMACY #129
HV00789 HOPEHEALTH, INC.

Covered Entity Details

Entity Name

HOPEHEALTH, INC.

Subdivision Name

Type

Ryan White Part C

340B ID

HV00789

Entity Address

360 N. Irby Street
FLORENCE, SC 29501

Grant Number

H76HA00789

Participating Start Date

7/1/2003

Last Recertification Date

2/20/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

KJS PHARMACY #129

Pharmacy Address

240 KELLEY STREET
LAKE CITY, SC 29560

Pharmacy Comments

Contract Details

Approval Date

7/10/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Carl Humphries, CEO
(843) 667-9414 Ext: 1500

Contract Pharmacy Representative

Spencer Player, Pharmacist
(843) 374-1110

Signed By Date

7/10/2014