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PIGGLY WIGGLY PHARMACY #196
CHC28973-02 GENESIS HEALTHCARE, INC
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Covered Entity Details
Entity Name
GENESIS HEALTHCARE, INC
Subdivision Name
Pee Dee Health Care
Type
HRSA-Funded Health Center
340B ID
CHC28973-02
Entity Address
201 Cashua Street
Darlington, SC 29532-3301
Grant Number
H80CS28973
Participating Start Date
6/27/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
PIGGLY WIGGLY PHARMACY #196
Pharmacy Address
100 NORTH RAILROAD AVENUE
LAMAR, SC 29069
Pharmacy Comments
Contract Details
Approval Date
1/11/2016
Contract Begin Date
1/14/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/27/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tony R. Megna, CEO
(803) 254-3676
Contract Pharmacy Representative
Donnie Stephens, Manager
(843) 326-7117
Signed By Date
1/11/2016
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