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SOUTH CAROLINA CVS PHARMACY, L.L.C.
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
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01140
101 FETLOCK DR.
MYRTLE BEACH, SC 29588
Pharmacy Comments
Contract Details
Approval Date
1/25/2023
Contract Begin Date
2/23/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/23/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Angela Williford, Chief Administrative Officer
(843) 347-8166
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/25/2023
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