Contract Pharmacy Details

MUSC RUTLEDGE TOWER AMB PHARMACY
RWII29425 MEDICAL UNIVERSITY OF SC INFECTIOUS DISEASES RYAN WHITE PROGRAM

Covered Entity Details

Entity Name

MEDICAL UNIVERSITY OF SC INFECTIOUS DISEASES RYAN WHITE PROGRAM

Subdivision Name

MUSC Ryan White Program

Type

Ryan White Part B

340B ID

RWII29425

Entity Address

135 Rutledge Ave.
MSC 752
Charleston, SC 29425

Grant Number

X07HA00038

Participating Start Date

4/1/2010

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

MUSC RUTLEDGE TOWER AMB PHARMACY

Pharmacy Address

MARVA WILLIAMS-LOWE, PHARMD
135 RUTLEDGE AVE
RM 106, MSC 584
CHARLESTON, SC 29425

Pharmacy Comments

Contract Details

Approval Date

10/20/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/6/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

LISA MONTGOMERY, VP FINANCE & ADMINISTRATION
(843) 792-5050

Contract Pharmacy Representative

Medical University Hospital Authority
Heather Easterling, Director, Pharmacy Services
(843) 792-5691

Signed By Date

10/20/2020

340B Drug Pricing Program Database