Contract Pharmacy Details

SOUTH CAROLINA CVS PHARMACY, L.L.C.
DSH420065 BON SECOURS - ST. FRANCIS XAVIER HOSPITAL

Covered Entity Details

Entity Name

BON SECOURS - ST. FRANCIS XAVIER HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH420065

Entity Address

2095 HENRY TECKLENBURG DRIVE
CHARLESTON, SC 29414

Medicare Provider Number

420065

Participating Start Date

10/1/2010

Last Recertification Date

9/4/2024

Entity Termination Date

7/1/2025

Pharmacy Details

Pharmacy Name

SOUTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05553
1401 BEN SAWYER BLVD.
MOUNT PLEASANT, SC 29464

Pharmacy Comments

Contract Details

Approval Date

4/15/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Christopher Lawrence Glenn, Director of Finance
(843) 789-1705

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/15/2022

340B Drug Pricing Program Database