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ESTILL COMMUNITY PHARMACY
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
ESTILL COMMUNITY PHARMACY
Pharmacy Address
ESTILL COMMUNITY PHARMACY LLC
137 MARTIN L KING JR HWY
P.O. BOX 335
ESTILL, SC 29918
Pharmacy Comments
Contract Details
Approval Date
7/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/26/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JULIE B. ALLEN, CFO
(803) 943-1254
Contract Pharmacy Representative
Heather Epton, PharmD
(803) 625-9001
Signed By Date
7/7/2017
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