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CAROLINA FOREST PHARMACY
DSH420049 CONWAY HOSPITAL
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Covered Entity Details
Entity Name
CONWAY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420049
Entity Address
300 SINGLETON RIDGE ROAD
CONWAY, SC 29526
Medicare Provider Number
420049
Participating Start Date
7/1/2019
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
CAROLINA FOREST PHARMACY
Pharmacy Address
4036 RIVER OAKS DR UNIT B-1
MYRTLE BEACH, SC 29579
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bret Alan Barr, CEO
(843) 347-8114
Contract Pharmacy Representative
Carolina Health Pharmacy LLC
Sameh Ibrahim, PIC/Owner
(843) 236-6500
Signed By Date
4/15/2022
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