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MCLEOD REGIONAL MEDICAL CENTER PHARMACY
DSH420005 MCLEOD MEDICAL CENTER - DILLON
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Covered Entity Details
Entity Name
MCLEOD MEDICAL CENTER - DILLON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420005
Entity Address
301 EAST JACKSON ST.
DILLON, SC 29536
Medicare Provider Number
420005
Participating Start Date
10/1/2006
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
MCLEOD REGIONAL MEDICAL CENTER PHARMACY
Pharmacy Address
555 E CHEVES ST
PO BOX 100551
FLORENCE, SC 29506-2617
Pharmacy Comments
04/10/2014 - Pharmacy name and address correction, changed in error on 3/28/2013, see history for details. 11/04/2011 updated zip (was 29501)
Contract Details
Approval Date
10/5/2011
Contract Begin Date
10/5/2011
Carve-In Effective Date
Contract Comments
04/29/2014 CP terminated in error on 3/27/2014, restored as active contract with original begin date
Contract Termination Date
Termination Reason
1/25/2017
Ownership change
Contacts
Covered Entity Signing Official
S. Fulton Ervin, III, Senior Vice President Finance and Chief Financial Officer
(843) 777-2917
Contract Pharmacy Representative
McLeod Health
S. Fulton Ervin, III, Senior Vice President Finance and Chief Financial Officer
(843) 777-2917
Signed By Date
9/28/2011
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