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EDC DRUG STORES, INC.
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
EDC DRUG STORES, INC.
Pharmacy Address
RITE AID #11628
611 HIGHWAY 301 NORTH
DILLON, SC 29536
Pharmacy Comments
Contract Details
Approval Date
1/16/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/9/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
S. Fulton Ervin, III, Senior Vice President Finance and Chief Financial Officer
(843) 777-2917
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/16/2014
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