Covered Entity Details

DSH420051Z MCLEOD REGIONAL MEDICAL CENTER (Active) - information as of 4/27/2025 12:55:42 AM

Main Details

Name

MCLEOD REGIONAL MEDICAL CENTER

Subdivision Name

MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Cardiology Associates Loris

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH420051Z

Medicare Provider Number

420051

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/13/2025

Participating Start Date

4/1/2025

Participating Approval Date

2/13/2025

Last Recertification Date

Contacts

Authorizing Official

McLeod Health
Christian Soura, Chief Financial Officer
(843) 777-5492

Primary Contact

McLeod Health
Hattie K. Hyman, PharmD, Pharmacy 340B Manager
(843) 777-5019

Addresses

Street Address

3485 MITCHELL ST
LORIS, SC 29569-2823

Billing Address

McLeod Regional Medical Center
555 E Cheves Street
Florence, SC 29506

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
SC	PG2355	1699756221,1902663529
NC	1902663529	1902663529,1699756221

Shipping Addresses

Shipping Address 1

McLeod Cardiology Associates Loris
3485 Mitchell Street
Loris, SC 29569

Shipping Address 2

McLeod Regional Medical Center
555 E Cheves Street
Florence, SC 29506

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH420051AA	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Cardiology Associates Myrtle Beach	107 MCLEOD HEALTH BLVD	MYRTLE BEACH	SC	Active
DSH420051AB	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Cardiology Associates Seacoast	3793 MCDOWELL LN	LITTLE RIVER	SC	Active
DSH420051AC	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - Southern Medical Associates	3418 CASEY ST	LORIS	SC	Active
DSH420051AD	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Regional Medical Center of the Pee Dee Inc d/b/a McLeod Rheumatology Seacoast - McLeod Rheumatology Seacoast	2021 North Myrtle Point Blvd	North Myrtle Beach	SC	Active
DSH420051AE	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - Palmetto Adult Medicine	1295 WILSON HALL RD	SUMTER	SC	Active
DSH420051B	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Employee Health Clinic	135 North Ravenel Street	Florence	SC	Terminated
DSH420051C	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	RSV Clinic	101 William H Johnson Street, Suite 400	Florence	SC	Terminated
DSH420051D	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Medical Park East-Chronic Care Management	101 William H Johnson Street, Suite 290	Florence	SC	Terminated
DSH420051E	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Home Health	300 South Dargan Street	Florence	SC	Terminated
DSH420051F	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Hospice House-Hospice of the Pee Dee	1203 East Cheves Street	Florence	SC	Active
DSH420051G	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Tower (Concourse Area)- Radiation Oncology	401 East Cheves Street	Florence	SC	Terminated
DSH420051H	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Tower (Concourse Area)-Infusion Services	401 E. Cheves Street	Florence	SC	Terminated
DSH420051J	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Family Medicine Center	144 North Ravenel Street	Florence	SC	Active
DSH420051K	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Oncology Hematology Associates - Oncology & Hematology	401 East Cheves Street	Florence	SC	Terminated
DSH420051L	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Oncology/Hematology Associates at Seacoast - Oncology/Hematology Clinic	4000 Hwy 9 East, Ste 250	Little River	SC	Active
DSH420051M	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	Infusion Services at Seacoast - Outpatient Service	4000 Hwy 9 East, Suite 2700	Little River	SC	Active
DSH420051N	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MRMC OF THE PEE DEE SURGERY CENTER - Outpatient Surgery	1005 E CHEVES ST	FLORENCE	SC	Active
DSH420051P	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	Main Tower (Concourse Area) - Cancer Center Clinic	401 East Cheves Street	Florence	SC	Terminated
DSH420051Q	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Digestive Health Seacoast	3980 HIGHWAY 9 E	LITTLE RIVER	SC	Active
DSH420051R	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Primary Care Seacoast	3980 HIGHWAY 9 E	LITTLE RIVER	SC	Active
DSH420051S	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Primary Care Carolina Forest 2	107 MCLEOD HEALTH BLVD	MYRTLE BEACH	SC	Active
DSH420051T	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Primary Care Carolina Forest 1	101 MCLEOD HEALTH BLVD	MYRTLE BEACH	SC	Active
DSH420051U	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	McLeod Regional Medical Center of the Pee Dee Inc d/b/a McLeod Plaza Family Medicine - McLeod Medical Plaza Family Practice	800 East Cheves Street	Florence	SC	Active
DSH420051V	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Family Medicine South	611 2ND LOOP RD	FLORENCE	SC	Active
DSH420051W	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - Jeter & Skinner Family Practice	800 E CHEVES ST	FLORENCE	SC	Active
DSH420051X	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Neurological Associates Florence	800 E CHEVES ST	FLORENCE	SC	Active
DSH420051Y	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Neurology Seacoast	3980 HIGHWAY 9 E	LITTLE RIVER	SC	Active
DSH420051Z	Child	DSH	MCLEOD REGIONAL MEDICAL CENTER	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Cardiology Associates Loris	3485 MITCHELL ST	LORIS	SC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Contacts	Authorizing Official	Update	Change Request	Ervin, III, S. Fulton Senior Vice President Finance and Chief Financial Officer McLeod Health 8437772917	Soura, Christian Chief Financial Officer McLeod Health 8437775492	3/28/2025 7:19 AM
Addresses	Billing Address	Insert	New Registration		McLeod Regional Medical Center 555 E Cheves Street Florence, SC 29506	2/13/2025 9:38 AM
Contacts	Signed By	Insert	New Registration		Ervin, III, S. Fulton Senior Vice President Finance and Chief Financial Officer McLeod Health 8437772917	2/13/2025 9:38 AM
Details	340B ID	Update	New Registration		DSH420051Z	2/13/2025 9:38 AM
Details	Entity Subname	Update	New Registration	MCLEOD REGIONAL MEDICAL CENTER OF T	MCLEOD REGIONAL MEDICAL CENTER OF T - McLeod Cardiology Associates Loris	2/13/2025 9:38 AM
Dates	Participating Approval Date	Update	New Registration		2/13/2025 9:38:19 AM	2/13/2025 9:38 AM
Details	State	Update	New Registration	Pending	Approved	2/13/2025 9:38 AM
Dates	Signed By Date	Update	New Registration		1/29/2025 4:38:23 PM	2/13/2025 9:38 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	2/13/2025 9:38 AM
Addresses	Shipping Address	Delete	New Registration	McLeod Consolidated Service Center 1145 Day Street Florence, SC 29506		1/29/2025 4:38 PM
Addresses	Billing Address	Insert	New Registration		McLeod Regional Medical Center 555 E Cheves Street Florence, SC 29506	1/29/2025 4:38 PM
Addresses	Main Address	Insert	New Registration		3485 MITCHELL ST LORIS, SC 29569-2823	1/13/2025 3:13 PM
Addresses	Billing Address	Insert	New Registration		McLeod Regional Medical Center 555 E Cheves Street Florence, SC 29506	1/13/2025 3:13 PM
Addresses	Shipping Address	Insert	New Registration		McLeod Cardiology Associates Loris 3485 Mitchell Street Loris, SC 29569	1/13/2025 3:13 PM
Addresses	Shipping Address	Insert	New Registration		McLeod Regional Medical Center 555 E Cheves Street Florence, SC 29506	1/13/2025 3:13 PM
Addresses	Shipping Address	Insert	New Registration		McLeod Consolidated Service Center 1145 Day Street Florence, SC 29506	1/13/2025 3:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/13/2025 3:13 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		PG2355	1/13/2025 3:13 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		SC	1/13/2025 3:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/13/2025 3:13 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1902663529	1/13/2025 3:13 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NC	1/13/2025 3:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1699756221	1/13/2025 3:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	1/13/2025 3:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1902663529	1/13/2025 3:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	1/13/2025 3:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1902663529	1/13/2025 3:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	1/13/2025 3:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1699756221	1/13/2025 3:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	1/13/2025 3:13 PM
Contacts	Authorizing Official	Insert	New Registration		Ervin, III, S. Fulton Senior Vice President Finance and Chief Financial Officer McLeod Health 8437772917	1/13/2025 3:13 PM
Contacts	Primary Contact	Insert	New Registration		Hyman, PharmD, Hattie K. Pharmacy 340B Manager McLeod Health 8437775019	1/13/2025 3:13 PM
Details	Assistance Received From Date	Insert	New Registration			1/13/2025 3:13 PM
Details	Assistance Received To Date	Insert	New Registration			1/13/2025 3:13 PM
Details	Last Recertification Date	Insert	New Registration			1/13/2025 3:13 PM
Details	Grant Number	Insert	New Registration			1/13/2025 3:13 PM
Details	340B ID	Insert	New Registration			1/13/2025 3:13 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/13/2025 3:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/13/2025 3:13 PM
Details	Medicare Provider Number	Insert	New Registration		420051	1/13/2025 3:13 PM
Details	Entity Name	Insert	New Registration		MCLEOD REGIONAL MEDICAL CENTER	1/13/2025 3:13 PM
Details	NOFO Number	Insert	New Registration			1/13/2025 3:13 PM
Details	Program Code	Insert	New Registration		DSH	1/13/2025 3:13 PM
Details	Entity Subname	Insert	New Registration		MCLEOD REGIONAL MEDICAL CENTER OF T	1/13/2025 3:13 PM
Dates	Participating Approval Date	Insert	New Registration			1/13/2025 3:13 PM
Details	State	Insert	New Registration		Pending	1/13/2025 3:13 PM
Dates	Registration Date	Insert	New Registration		1/13/2025 3:13:42 PM	1/13/2025 3:13 PM
Dates	Signed By Date	Insert	New Registration			1/13/2025 3:13 PM
Dates	Start Date	Insert	New Registration			1/13/2025 3:13 PM
Terminations	Termination Comments	Insert	New Registration			1/13/2025 3:13 PM
Terminations	Termination Date	Insert	New Registration			1/13/2025 3:13 PM
Terminations	Termination Effective Date	Insert	New Registration			1/13/2025 3:13 PM
Terminations	Termination Reason	Insert	New Registration			1/13/2025 3:13 PM