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SOUTH CAROLINA CVS PHARMACY, L.L.C.
RWII292011A CAN Community Health, Inc.
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Covered Entity Details
Entity Name
CAN Community Health, Inc.
Subdivision Name
Columbia
Type
Ryan White Part B
340B ID
RWII292011A
Entity Address
1911 Hampton St
Columbia, SC 29201
Grant Number
X07HA00038
Participating Start Date
7/1/2019
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07516
3595 HARDEN ST
COLUMBIA, SC 29203
Pharmacy Comments
Contract Details
Approval Date
4/17/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard E. Carlisle, President & CEO
(941) 366-0134 Ext: 11111
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/17/2020
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