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MANIFEST PHARMACY, LLC
CH04813E VALLEY HEALTHCARE SYSTEM, INC.
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Covered Entity Details
Entity Name
VALLEY HEALTHCARE SYSTEM, INC.
Subdivision Name
VHcS Fortson Medical/Dental Center
Type
HRSA-Funded Health Center
340B ID
CH04813E
Entity Address
94 Mccrary Rd
Fortson, GA 31808-4558
Grant Number
H80CS00678
Participating Start Date
10/1/2009
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
MANIFEST PHARMACY, LLC
Pharmacy Address
1018 S BATESVILLE RD
STE 4A
GREER, SC 29650-5203
Pharmacy Comments
Contract Details
Approval Date
4/12/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/21/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
SARAH E. LANG, CEO
(706) 322-9599 Ext: 1011
Contract Pharmacy Representative
Benjamin Walvoord, President
(864) 990-2880
Signed By Date
4/12/2013
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