Contract Pharmacy Details

BI-LO PHARMACY #5707
CHC28973-00 GENESIS HEALTHCARE, INC

Covered Entity Details

Entity Name

GENESIS HEALTHCARE, INC

Subdivision Name

Olanta Family Care

Type

HRSA-Funded Health Center

340B ID

CHC28973-00

Entity Address

211 S Jones Rd
Olanta, SC 29114-9705

Grant Number

H80CS28973

Participating Start Date

6/27/2018

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

BI-LO PHARMACY #5707

Pharmacy Address

550 ROBERTSON BLVD
WALTERBORO, SC 29488

Pharmacy Comments

Contract Details

Approval Date

1/14/2018

Contract Begin Date

4/1/2018

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

BILO
DAVID CHISM, SR. DIRECTOR
(904) 370-6455

Signed By Date

1/14/2018