Contract Pharmacy Details

SOUTH CAROLINA CVS PHARMACY, L.L.C.
DSH340008 SCOTLAND MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

SCOTLAND MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH340008

Entity Address

500 LAUCHWOOD DRIVE
LAURINBURG, NC 28352

Medicare Provider Number

340008

Participating Start Date

7/1/2004

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

SOUTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05518
1085 COTTINGHAM BLVD., #3
BENNETTSVILLE, SC 29512

Pharmacy Comments

Contract Details

Approval Date

1/18/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/16/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

David L Pope, Senior Vice President, Operations
(910) 291-7502

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/18/2020

340B Drug Pricing Program Database