Contract Pharmacy Details

WALMART PHARMACY 10-3724
DSH420068 THE REGIONAL MEDICAL CENTER (TRMC)

Covered Entity Details

Entity Name

THE REGIONAL MEDICAL CENTER (TRMC)

Subdivision Name

OF ORANGEBURG & CALHOUN COUNTIES

Type

Disproportionate Share Hospital

340B ID

DSH420068

Entity Address

3000 ST. MATTHEWS ROAD
ORANGEBURG, SC 29118

Medicare Provider Number

420068

Participating Start Date

7/1/2004

Last Recertification Date

9/9/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

WALMART PHARMACY 10-3724

Pharmacy Address

332 STONE WALL JACKSON BLVD
ORANGEBURG, SC 29115

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

5/3/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Rick George Langosch, Interim CFO
(803) 395-4485

Contract Pharmacy Representative

Walmart
George Flaherty, Senior Director Payer Programs
(479) 204-9374

Signed By Date

4/15/2021

340B Drug Pricing Program Database