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WALGREEN CO.
RRC420065-00 BON SECOURS ST. FRANCIS XAVIER HOSPI
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Covered Entity Details
Entity Name
BON SECOURS ST. FRANCIS XAVIER HOSPI
Subdivision Name
Type
Rural Referral Center
340B ID
RRC420065-00
Entity Address
2095 HENRY TECKLENBURG DRIVE
CHARLESTON, SC 29414
Medicare Provider Number
420065
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 07156
1810 N HWY 17
MT PLEASANT, SC 29464-3309
Pharmacy Comments
Contract Details
Approval Date
4/25/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rebecca Ann Tucker, SVP, Chief Financial Officer
(843) 727-3403
Contract Pharmacy Representative
Bon Secours Saint Francis Hospital
Louis Glavinos, 340B Pharmacy Manager and Oncology Outpatient Pharmacy Infusion Manager
(843) 402-1675
Signed By Date
4/23/2025
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