Contract Pharmacy Details

SOUTH CAROLINA CVS PHARMACY, L.L.C.
DSH420091 MUSC Health Florence Medical Center

Covered Entity Details

Entity Name

MUSC Health Florence Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH420091

Entity Address

805 PAMPLICO HIGHWAY
FLORENCE, SC 29505

Medicare Provider Number

420091

Participating Start Date

1/1/2020

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

SOUTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07384
120 NORTH LONGSTREET ST.
KINGSTREE, SC 29556

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Lisa Goodlett, Chief Financial Officer
(843) 792-4775

Contract Pharmacy Representative

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

Signed By Date

10/15/2020

340B Drug Pricing Program Database