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CAROLINA FOREST PHARMACY
FQHCLA372 CARETEAM PLUS, INC.
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Covered Entity Details
Entity Name
CARETEAM PLUS, INC.
Subdivision Name
Careteam + Family Health and Specialty Care
Type
Health Center Program Look-Alike
340B ID
FQHCLA372
Entity Address
100 Professional Park Dr
Conway, SC 29526-9260
Grant Number
LALCS31819
Participating Start Date
10/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CAROLINA FOREST PHARMACY
Pharmacy Address
4036 RIVER OAKS DR UNIT B-1
MYRTLE BEACH, SC 29579
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Johanna Haynes, Executive Director
(843) 234-8220
Contract Pharmacy Representative
Carolina Health Pharmacy LLC
Sameh Ibrahim, PIC/Owner
(843) 236-6500
Signed By Date
4/15/2024
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