Contract Pharmacy Details

SOUTH CAROLINA CVS PHARMACY, L.L.C.
DSH420051 MCLEOD REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

MCLEOD REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH420051

Entity Address

555 EAST CHEVES STREET
FLORENCE, SC 29506

Medicare Provider Number

420051

Participating Start Date

7/1/2006

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

SOUTH CAROLINA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07300
2501 SECOND LOOP RD.
FLORENCE, SC 29501

Pharmacy Comments

Contract Details

Approval Date

4/16/2012

Contract Begin Date

4/16/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

S. Fulton Ervin, III, Senior Vice President Finance and Chief Financial Officer
(843) 777-2917

Contract Pharmacy Representative

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

Signed By Date

3/22/2012

340B Drug Pricing Program Database