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CVS TN DISTRIBUTION, LLC
SCH420072-00 HAMPTON REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
HAMPTON REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH420072-00
Entity Address
503 CAROLINA WEST
VARNVILLE, SC 29944
Medicare Provider Number
420072
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
CVS TN DISTRIBUTION, LLC
Pharmacy Address
10017 KINGSTON PIKE
KNOXVILLE, TN 37922
Pharmacy Comments
Contract Details
Approval Date
10/1/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JULIE B. ALLEN, CFO
(803) 943-1254
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
10/1/2014
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