Contract Pharmacy Details

MANIFEST PHARMACY, LLC
CH04523N CARESOUTH CAROLINA,INC

Covered Entity Details

Entity Name

CARESOUTH CAROLINA,INC

Subdivision Name

CSC Bennettsville Pediatric Center

Type

HRSA-Funded Health Center

340B ID

CH04523N

Entity Address

210 W Main St.
Bennettsville, SC 29512

Grant Number

H80CS00654

Participating Start Date

4/1/2013

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

4/11/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/20/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Ann Lewis, CEO
(843) 857-0111

Contract Pharmacy Representative

Benjamin Walvoord, President
(864) 990-2880

Signed By Date

4/11/2013

340B Drug Pricing Program Database