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SOUTH CAROLINA CVS PHARMACY, L.L.C.
RWII29405 Lowcountry AIDS Services
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Covered Entity Details
Entity Name
Lowcountry AIDS Services
Subdivision Name
Type
Ryan White Part B
340B ID
RWII29405
Entity Address
5064 Rivers Ave
North Charleston, SC 29406
Grant Number
X07HA00038
Participating Start Date
4/1/2013
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03977
1506 EAST MONTAGUE AVE
NORTH CHARLESTON, SC 29405
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brad Childs, Executive Director
(843) 747-2273
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/12/2023
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