Contract Pharmacy Details

CAROLINA DRUG STORE
FQHCLA274 GENESIS HEALTH CARE, INC.

Covered Entity Details

Entity Name

GENESIS HEALTH CARE, INC.

Subdivision Name

Type

Health Center Program Look-Alike

340B ID

FQHCLA274

Entity Address

201 CASHUA STREET
DARLINGTON, SC 29532

Grant Number

LALCS00092

Participating Start Date

1/7/2011

Last Recertification Date

2/9/2015

Entity Termination Date

1/1/2016

Pharmacy Details

Pharmacy Name

CAROLINA DRUG STORE

Pharmacy Address

52 PUBLIC SQ
DARLINGTON, SC 29532-3216

Pharmacy Comments

Contract Details

Approval Date

2/27/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Tony Megna, CEO
(803) 254-3676

Contract Pharmacy Representative

Jean L. Weaver, President
(843) 393-2865

Signed By Date

1/11/2013