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SOUTH CAROLINA CVS PHARMACY, L.L.C.
CAH421302-00 FAIRFIELD MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
FAIRFIELD MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH421302-00
Entity Address
102 US HWY 321 BYPASS NORTH
WINNSBORO, SC 29180
Medicare Provider Number
421302
Participating Start Date
4/1/2015
Last Recertification Date
8/15/2018
Entity Termination Date
1/1/2019
Pharmacy Details
Pharmacy Name
SOUTH CAROLINA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05474
27 US HIGHWAY 321 BYP S
WINNSBORO, SC 29180
Pharmacy Comments
Contract Details
Approval Date
7/2/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael L. Williams, Chief Executive Officer
(803) 635-0233
Contract Pharmacy Representative
CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467
Signed By Date
7/2/2015
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