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FREDS PHARMACY #3171
CH041190 BEAUFORT-JASPER-HAMPTON COMPREHENSIVE HEALTH SERVICES, INCORPORATED
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Covered Entity Details
Entity Name
BEAUFORT-JASPER-HAMPTON COMPREHENSIVE HEALTH SERVICES, INCORPORATED
Subdivision Name
RUTH P. FIELD MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH041190
Entity Address
719 N Okatie Hwy
Ridgeland, SC 29936-8276
Grant Number
H80CS00699
Participating Start Date
12/1/1992
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
FREDS PHARMACY #3171
Pharmacy Address
181 WEST CAROLINA AVENUE
P.O. BOX 1326
VARNVILLE, SC 29944
Pharmacy Comments
Contract Details
Approval Date
4/26/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/7/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Roland J Gardner, CEO
(843) 987-7448 Ext: 7448
Contract Pharmacy Representative
Fred's Pharmacy
Betty Ngo, Sr. Director 340B Program Operations
(901) 481-0346
Signed By Date
4/26/2017
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