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SOUTH CAROLINA CVS PHARMACY, L.L.C.
DSH420070 PRISMA HEALTH TUOMEY HOSPITAL
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Covered Entity Details
Entity Name
PRISMA HEALTH TUOMEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420070
Entity Address
129 N WASHINGTON ST
SUMTER, SC 29150-4949
Medicare Provider Number
420070
Participating Start Date
4/1/2006
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03541
109 HIGHWAY 28 BY-PASS
ANDERSON, SC 29624
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Louis Smith, Chief Executive Officer
(803) 774-8603
Contract Pharmacy Representative
CVS Pharmacies
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
4/15/2021
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