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PIGGLY WIGGLY PHARMACY #48
HV00789 HOPEHEALTH, INC.
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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
PIGGLY WIGGLY PHARMACY #48
Pharmacy Address
269 NORTH RON MCNAIR BOULEVARD
LAKE CITY, SC 29560
Pharmacy Comments
10/25/2010 - ADDRESS CHANGED FROM 212 WEST MAIN STREET.
Contract Details
Approval Date
10/16/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Carl Humphries, CEO
(843) 667-9414 Ext: 1500
Contract Pharmacy Representative
SPENCER PLAYER, OWNER
(843) 394-3121
Signed By Date
10/16/2015
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