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SOUTH CAROLINA CVS PHARMACY, L.L.C.
CAH151313-00 WOODLAWN HOSPITAL
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Covered Entity Details
Entity Name
WOODLAWN HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151313-00
Entity Address
1400 EAST 9TH STREET
ROCHESTER, IN 46975
Medicare Provider Number
151313
Participating Start Date
1/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00487
1858 REMOUNT RD
HANAHAN, SC 29410
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/19/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Carl John Kraft, Vice Pesident
(574) 224-1118
Contract Pharmacy Representative
Wellpartner
Joshua Thevenin, Account Manager
(646) 761-3048
Signed By Date
10/14/2021
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