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WALMART PHARMACY 10-4445
SCH420038-00 Prisma Health Laurens County Hospital
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Covered Entity Details
Entity Name
Prisma Health Laurens County Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH420038-00
Entity Address
22725 HIGHWAY 76 EAST
CLINTON, SC 29325
Medicare Provider Number
420038
Participating Start Date
10/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4445
Pharmacy Address
680 OLD GREENVILLE HWY
CLEMSON, SC 29631
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Justin Matthew Benfield, Chief Operations Executive
(864) 933-9150
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/14/2023
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