Covered Entity Details

DSH420004 MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Active) - information as of 4/27/2025 12:48:42 AM

Main Details

Name

MEDICAL UNIVERSITY HOSPITAL AUTHORITY

Subdivision Name

MEDICAL UNIVERSITY HOSPITAL

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH420004

Medicare Provider Number

420004

Additional Details

Current Program Status

Active

Registration Date

9/4/2007

Participating Start Date

12/1/1992

Participating Approval Date

9/4/2007

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Medical University Hospital Authority
Thomas C Crawford, Chief Operating Officer
(843) 792-8775

Primary Contact

MUSC Health
Sharelle Brown, Executive System Director Pharmacy Business and Finance
(248) 396-8085

Addresses

Street Address

169 ASHLEY AVENUE
CHARLESTON, SC 29425

Billing Address

MEDICAL UNIVERSITY HOSPITAL AUTHORITY
PO Box 31244
Salt Lake City, UT 84131

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
11/22/11, added ship to addr.(at 230 albemarle) 1/21/09 UPDATED ADDR (WAS 171 ASHLEY AVE.) 2/24/04 UPDATED MEDICAID # (WAS 702798, 708630)	11/22/2011
1/21/09 UPDATED ADDR (WAS 171 ASHLEY AVE.) 2/24/04 UPDATED MEDICAID # (WAS 702798, 708630)	12/02/2010

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	178277,160808	1659435840,1659470433,1730329467,1659511061,1497039390,1821238551,1295840148,1083171185,1639737349,1770280299,1073605879
NC	178277,160808	1073605879,1770280299,1659435840
GA	178277,160808	1073605879,1770280299,1659435840

Shipping Addresses

Shipping Address 1

MUSC- Mail Order Pharmacy
7771 Palmetto Commerce Parkway
Room 404
North Charleston, SC 29420

Shipping Address 2

MUSC University Hospital Pharmacy
169 Ashley Avenue, Room 149
Charleston, SC 29425

Shipping Address 3

MUSC Rutledge Towers Outpatient
135 Rutledge Avenue, Room 106
Charleston, SC 29425

Shipping Address 4

MUSC Holllings Cancer Ctr Pharmacy
86 Jonathan Lucas St, Room 114
Charleston, SC 29425

Shipping Address 5

MUSC Institute of Psychiatry Pharmacy
67 President Street
room PH448
Charleston, SC 29425

Shipping Address 6

MUSC Ashley River Tower Phmy
25 Courtenay Drive, Room M-104
Charleston, SC 29425

Shipping Address 7

MUSC - NORTH CHARLESTON PHARMACY
2575 Elms Center Road
Suite 100
NORTH CHARLESTON, SC 29406

Shipping Address 8

MUSC Rutledge Towers Ambulatory OR
135 Rutledge Avenue, 120H
Charleston, SC 29425

Shipping Address 9

MUSC Hollings Cancer Infusion Ctr Pharmacy
86 Jonathan Lucas Street
Charleston, SC 29425

Shipping Address 10

MUSC Ashley River Twr Phmy
25 Courtenay Drive, Room 2007
Charleston, SC 29425

Shipping Address 11

MUSC-Pharmacy Compounding Center
650 Ellis Oak Dr
Charleston, SC 29412

Shipping Address 12

MUSC CHILDRENS HLTH MED PAV PHARM
2250 MALL DR
NORTH CHARLESTON, SC 29406

Shipping Address 13

MUSC CHILDRENS HLTH MED PAVIL INFUS
2250 MALL DR
NORTH CHARLESTON, SC 29406

Shipping Address 14

MUSC Children's Hospital Pharmacy
10 McClennan Banks Dr.
Suite 2136
Charleston, SC 29425

Shipping Address 15

Safecor
4060 Business Park Dr.
Columbus, OH 43204

Shipping Address 16

MUSC Health West Infusion Center Pharmacy
2060 Sam Rittenburg Blvd
Unit# E708
RM# SK2061
Charleston, SC 29407

Shipping Address 17

MUSC Health Chuck Dawley Medical Park
1106 Chuck Dawley Blvd
Building A
Mount Pleasant, SC 29464

Shipping Address 18

Medical University of South Carolina (MUSC) Consolidated Service Center
7771 Palmetto Commerce Parkway
Suite 401
North Charleston, SC 29420

Shipping Address 19

MUSC - University Hospital Pharmacy
169 Ashley Avenue Room# 462
Charleston, SC 29425

Shipping Address 20

MUSC - Family Medicine Pharmacy
650 Ellis Oak Ave
Rm 119
Charleston, SC 29412-3089

Shipping Address 21

MUSC Health Orangeburg Hospital Pharmacy
3000 Saint Matthews Rd
Orangeburg, SC 29118-1442

Shipping Address 22

MUSC HEALTH H.F.Mabry Cancer Center Pharmacy
1161 Cook Rd
Orangeburg, SC 29118

Shipping Address 23

MUSC
165 Ashley Ave
EH 208
Charleston, SC 49425

Shipping Address 24

MUSC
169 Ashley Ave
MH 208 Room 161
Charleston, SC 29425

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/17/2015	10/01/2015		02/27/2017
Contract Detail	ACCREDO HEALTH GROUP INC	201 GREAT CIRCLE ROAD		NASHVILLE	TN	37228	07/17/2015	10/01/2015	08/01/2017	02/08/2018
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/17/2015	10/01/2015		02/27/2017
Contract Detail	ACCREDO HEALTH GROUP INC	422 GALLIMORE DAIRY RD	SUITE A	GREENSBORO	NC	27409	07/09/2019	10/01/2019		10/01/2019
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/11/2021	01/01/2022		04/06/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/17/2015	10/01/2015	07/01/2023	07/10/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/17/2015	10/01/2015		02/27/2017
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/17/2015	10/01/2015		02/27/2017
Contract Detail	ACCREDO HEALTH GROUP, INC.	11411 STRANG LINE RD	STE A	LENEXA	KS	66215	10/11/2021	01/01/2022	01/01/2022	04/06/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/06/2023	07/01/2023		07/01/2023
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/11/2024	10/01/2024		10/01/2024
Contract Detail	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	01/16/2025	04/01/2025		04/01/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	10/09/2023	01/01/2024		01/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/09/2023	01/01/2024		01/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	10/09/2023	01/01/2024		01/01/2024
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/14/2022	10/01/2022		10/01/2022
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	30 GARFIELD STREET SUITE B	ASHEVILLE	NC	28803	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	9401-J SOUTHERN PINE BLVD	CHARLOTTE	NC	28273	07/17/2017	10/01/2017	07/21/2022	11/08/2022
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	5955 CORE ROAD SUITE 512	NORTH CHARLESTON	SC	29406-6085	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	6 SPRING MILL DR	MALVERN	PA	19355	04/14/2025	07/01/2025		04/14/2025
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	2345 WATERS DRIVE	MENDOTA HEIGHTS	MN	55120	04/14/2025	07/01/2025		04/14/2025
Contract Detail	CORAM HEALTHCARE/CAROLINA HOME THERAPEUT	720 GRACERN ROAD	SUITE 123	COLUMBIA	SC	29210	07/17/2017	10/01/2017		10/01/2017
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 03295	1241 LEXINGTON AVE,	NEW YORK	NY	10028	10/12/2022	01/01/2023	01/01/2023	01/30/2023
Contract Detail	CVS ALBANY, L.L.C.	DBA: CVS/PHARMACY # 03295	1241 LEXINGTON AVE,	NEW YORK	NY	10028	04/06/2023	07/01/2023	05/16/2024	07/11/2024
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/15/2022	07/01/2022		07/01/2022
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/15/2022	07/01/2022		07/01/2022
Contract Detail	CVS TN DISTRIBUTION, LLC	10017 KINGSTON PIKE		KNOXVILLE	TN	37922	10/16/2014	01/01/2015	06/02/2020	04/11/2023
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/14/2022	10/01/2022		10/01/2022
Contract Detail	CYSTIC FIBROSIS SERVICES	CYSTIC FIBROSIS SERVICES, INC	10530 JOHN W ELLIOTT DR, STE 200	FRISCO	TX	75033	04/15/2016	07/01/2016	08/09/2017	08/10/2017
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	06/28/2017	07/01/2017		06/28/2017
Contract Detail	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	10/09/2023	01/01/2024		01/01/2024
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/13/2020	07/01/2020		07/01/2020
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/13/2020	07/01/2020		07/01/2020
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/13/2020	07/01/2020		07/01/2020
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/11/2023	07/01/2023		07/01/2023
Contract Detail	GENOA HEALTHCARE LLC	4 HARBISON WAY		COLUMBIA	SC	29212	01/16/2025	04/01/2025		04/01/2025
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07758	410 S. COLUMBIA AVE.	RINCON	GA	31326	07/14/2022	10/01/2022		10/01/2022
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00060	7300 GA HIGHWAY 21	PORT WENTWORTH	GA	31407	07/14/2022	10/01/2022		10/01/2022
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04567	5421 NEW JESUP HWY.	BRUNSWICK	GA	31523	07/14/2022	10/01/2022		10/01/2022
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02544	101 LEXINGTON CIRCLE	PEACHTREE CITY	GA	30269	07/14/2022	10/01/2022		10/01/2022
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01586	3001 RICHARD B. RUSSELL PARKWAY	WARNER ROBINS	GA	31088	07/14/2022	10/01/2022		10/01/2022
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16526	2535 DALLAS HWY SW	MARIETTA	GA	30064	10/12/2022	01/01/2023	01/01/2023	01/30/2023
Contract Detail	GEORGIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16526	2535 DALLAS HWY SW	MARIETTA	GA	30064	04/06/2023	07/01/2023		07/01/2023
Contract Detail	GROVE PARK PHARMACY	1324 GROVE PARK DR		ORANGEBURG	SC	29115-2911	04/06/2023	04/18/2023	11/20/2023	11/20/2023
Contract Detail	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/16/2025	04/01/2025		04/01/2025
Contract Detail	MUSC FAMILY MEDICINE PHARMACY	MARVA WILLIAMS-LOWE, PHARMD	650 ELLIS OAK AVE RM 119	CHARLESTON	SC	29412	07/11/2013	10/01/2013	01/01/2022	01/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03896	9308 KENDALL DR.	CHARLOTTE	NC	28214	07/14/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07941	8420 STEELE CREEK RD.	CHARLOTTE	NC	28273	07/14/2022	10/01/2022		10/01/2022
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04622	3625 S. COLLEGE RD.	WILMINGTON	NC	28412	07/14/2022	10/01/2022		10/01/2022
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	01/13/2020	04/01/2020		04/01/2020
Contract Detail	OPTUM FRONTIER THERAPIES, LLC	325 W ATHERTON RD	SUITE 1	FLINT	MI	48507-2601	09/18/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 103, LLC	9204 BERGER RD.	STE. A	COLUMBIA	MD	21046-1729	07/12/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 200, INC	5895 CORE RD	STE 417	NORTH CHARLESTON	SC	29406	07/12/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 209, INC.	425 FRANKLIN GATEWAY	SUITE 535	MARIETTA	GA	30067-7736	07/12/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	4000 CHEMICAL RD STE 100		PLYMOUTH MEETING	PA	19462	07/12/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	07/12/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 550, LLC	7167 E. KEMPER RD.		CINCINNATI	OH	45249	07/12/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM INFUSION SERVICES 553, LLC	6531 MERIDIEN DR	SUITE 113	RALEIGH	NC	27616	07/12/2023	10/01/2023		10/01/2023
Contract Detail	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	10/12/2022	01/01/2023		01/01/2023
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	10/12/2022	01/01/2023		01/01/2023
Contract Detail	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/16/2025	04/01/2025		04/01/2025
Contract Detail	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	01/16/2025	04/01/2025		04/01/2025
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/13/2020	04/01/2020		04/01/2020
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	10/12/2022	01/01/2023		01/01/2023
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	01/13/2020	04/01/2020		04/01/2020
Contract Detail	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	10/12/2022	01/01/2023		01/01/2023
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	01/13/2020	04/01/2020		04/01/2020
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/12/2022	01/01/2023		01/01/2023
Contract Detail	PALMETTO INFUSION SERVICES LLC	217 DOZIER BLVD	STE 102	FLORENCE	SC	29501	10/11/2021	01/01/2022	01/01/2022	04/06/2023
Contract Detail	PALMETTO INFUSION SERVICES LLC	D/B/A PALMETTO INFUSION SERVICES	3105 SUNSET BLVD	WEST COLUMBIA	SC	29169	10/11/2021	01/01/2022	01/01/2022	04/06/2023
Contract Detail	PALMETTO INFUSION SERVICES, LLC	D/B/A PALMETTO INFUSION SERVICES	9295 MEDICAL PLAZA DR STE C	NORTH CHARLESTON	SC	29406-9137	10/11/2021	01/01/2022	01/01/2022	04/06/2023
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/10/2017	10/01/2017	10/04/2022	04/21/2023
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/17/2017	10/01/2017		10/01/2017
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/14/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/14/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	CVS/PHARMACY #48637	2700 NORTHEAST EXPY NE STE B800 BUILDING B	ATLANTA	GA	30345	07/14/2022	10/01/2022		10/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/15/2022	10/01/2022		10/01/2022
Contract Detail	PUBLIX PHARMACY #0449	QUEENSBOROUGH SHOPPING CENTER	1000 JOHNNIE DODDS BLVD STE 106	MT PLEASANT	SC	29464	07/03/2013	10/01/2013	12/31/2023	12/31/2023
Contract Detail	PUBLIX PHARMACY #0459	ST JAMES SHOPPING CENTER	208-C ST JAMES AVENUE	GOOSE CREEK	SC	29445	07/03/2013	10/01/2013	12/31/2023	12/31/2023
Contract Detail	PUBLIX PHARMACY #0483	1575 OLD TROLLEY RD		SUMMERVILLE	SC	29485	07/03/2013	10/01/2013	12/31/2023	12/31/2023
Contract Detail	PUBLIX SUPER MARKET'S	PUBLIX PHARMACY #1463	61 LADYS ISLAND DR.	BEAUFORT	SC	29907	01/15/2019	04/01/2019	07/31/2022	11/14/2022
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #1081	1125 PARK WEST BLVD	MOUNT PLEASANT	SC	29466-6974	07/03/2013	10/01/2013	12/31/2023	12/31/2023
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0633	520 FOLLY ROAD	CHARLESTON	SC	29412	07/03/2013	10/01/2013	12/31/2023	12/31/2023
Contract Detail	PUBLIX SUPER MARKETS	DBA: PUBLIX PHARMACY #824	PALMETTO PAVILION 8409 DORCHESTER ROAD, STE 104	N CHARLESTON	SC	29420	07/03/2013	10/01/2013	12/31/2023	12/31/2023
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0671	2125 EAST CR 540-A	LAKELAND	FL	33813	01/15/2019	04/01/2019	07/31/2022	11/14/2022
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #1410	6767 US HIGHWAY 98 NORTH	LAKELAND	FL	33809-6226	01/15/2019	04/01/2019	07/31/2022	11/14/2022
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1145	3642 SAVANNAH HIGHWAY #132	JOHNS ISLAND	SC	29455	07/03/2013	10/01/2013	12/31/2023	12/31/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1055	1435 BEN SAWYER BLVD.	MOUNT PLEASANT	SC	29464	07/03/2013	10/01/2013	12/31/2023	12/31/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1120	1585 CENTRAL AVENUE, SUITE A	SUMMERVILLE	SC	29483	07/03/2013	10/01/2013	09/30/2021	09/30/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1266	1724 STATE RD.	SUMMERVILLE	SC	29486	07/03/2013	10/01/2013	12/31/2023	12/31/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1205	101 BUCKWALTER PLACE BLVD.	BLUFFTON	SC	29910	01/15/2019	04/01/2019	07/31/2022	11/14/2022
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1354	112 NICKEL PLATE RD	HARDEEVILLE	SC	29927	01/15/2019	04/01/2019	07/31/2022	11/14/2022
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	01/15/2019	04/01/2019	12/31/2023	12/31/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1383	847 HIGHWAY 378 WEST	LEXINGTON	SC	29072	01/15/2019	04/01/2019	07/31/2022	11/14/2022
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	01/15/2019	04/01/2019	12/31/2023	12/31/2023
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1599	10 WESTEDGE ST, STE 100	CHARLESTON	SC	29403	01/06/2020	04/01/2020	07/31/2022	11/14/2022
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #472	1401 SAM RITTENBERG BOULEVARD	CHARLESTON	SC	29407	01/06/2020	04/01/2020	07/31/2022	11/14/2022
Contract Detail	PUBLIX TENNESSEE, LLC	PUBLIX PHARMACY #1298	6614 CHARLOTTE PIKE	NASHVILLE	TN	37209	01/15/2019	04/01/2019	07/31/2022	11/14/2022
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/09/2023	01/01/2024		01/01/2024
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	10/09/2023	01/01/2024		01/01/2024
Contract Detail	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	10/09/2023	01/01/2024		01/01/2024
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00483	983 HARBORVIEW RD	CHARLESTON	SC	29412	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00529	2803 MAYBANK HWY	JOHNS ISLAND	SC	29455	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00626	8995 UNIVERSITY BLVD	NORTH CHARLESTON	SC	29406	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02243	2566 ASHELY RIVER ROAD	CHARLESTON	SC	29414	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03564	1015 KING ST.	CHARLESTON	SC	29403	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03801	2152 SAVANNAH HWY.	CHARLESTON	SC	29414	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03870	4400 DORCHESTER RD	CHARLESTON	SC	29405	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03977	1506 EAST MONTAGUE AVE	NORTH CHARLESTON	SC	29405	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04204	301 N MAIN ST	SUMMERVILLE	SC	29483	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04263	1676 NORTH HIGHWAY 17	MOUNT PLEASANT	SC	29464	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05845	640 LONG POINT RD.	MT PLEASANT	SC	29464	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07159	2884 HWY 17 NORTH	MT PLEASANT	SC	29466	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07305	65 SYCAMORE AVE	CHARLESTON	SC	29407	04/15/2013	07/01/2013	05/05/2022	04/06/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07537	5215 ASHLEY PHOSPHATE RD.	NORTH CHARLESTON	SC	29418	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07795	650 JOHNNIE DODDS BLVD.	MOUNT PLEASANT	SC	29464	04/15/2013	07/01/2013		02/27/2017
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #175	578 INTERNATIONAL DR	MYRTLE BEACH	SC	29579	04/15/2022	07/01/2022		07/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05555	8910 OLD NUMBER SIX HWY	SANTEE	SC	29142	04/15/2022	07/01/2022		07/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03892	18252 HERITAGE HWY	DENMARK	SC	29042	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05549	1008 LAKE MURRAY BOULEVARD	IRMO	SC	29063	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07531	206 S. MAIN ST./PO BOX 901	HEMINGWAY	SC	29554	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02250	121 CLEMSON RD	COLUMBIA	SC	29229	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03585	555 ROBERTSON BLVD.	WALTERBORO	SC	29488	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 11255	40 D. MARK CUMMINGS RD.	HARDEEVILLE	SC	29927	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04281	2500 BROAD STREET	CAMDEN	SC	29020	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01540	3411 SOCASTEE BLVD.	MYRTLE BEACH	SC	29588	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05552	6160 WADE HAMPTON BLVD.	TAYLORS	SC	29687	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05553	1401 BEN SAWYER BLVD.	MOUNT PLEASANT	SC	29464	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03578	120 WEST COLUMBIA AVENUE	BATESBURG	SC	29006	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03572	1535 JOHN C. CALHOUN DRIVE	ORANGEBURG	SC	29115	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03826	1500 RIBAUT ROAD	PORT ROYAL	SC	29935	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07398	#9 CORPORATE PARKWAY	GOOSE CREEK	SC	29445	07/14/2022	10/01/2022	04/20/2023	07/10/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05566	10 POPE AVENUE	HILTON HEAD ISLAND	SC	29928	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11003	225 FAISON ROAD	MOUNT PLEASANT	SC	29466	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03834	100 REMBERT DENNIS BLVD	MONCKS CORNER	SC	29461	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06410	431 B ST. JAMES AVE SUITE I	GOOSE CREEK	SC	29445	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07334	5608 SUNSET BLVD.	LEXINGTON	SC	29072	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07333	85 MATHEWS DR	HILTON HEAD ISLAND	SC	29926	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16859	1300 LONG GROVE DR	MOUNT PLEASANT	SC	29464	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05515	601 HWY 17 NORTH	SURFSIDE BEACH	SC	29575	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07338	2908 EMANUEL CHURCH ROAD	WEST COLUMBIA	SC	29170	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03849	3055 BROAD RIVER ROAD	COLUMBIA	SC	29210	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05548	5742 MEMORIAL BLVD.	SAINT GEORGE	SC	29477	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07609	3306 WEST PALMETTO ST.	FLORENCE	SC	29501	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02736	3710 HIGHWAY 17 BYPASS	MURRELLS INLET	SC	29576	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07300	2501 SECOND LOOP RD.	FLORENCE	SC	29501	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00563	1515 OLD TROLLEY RD	SUMMERVILLE	SC	29485	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08936	101 FOUNDERS BAY RD.	MURRELLS INLET	SC	29576	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03560	1020 ORANGE GROVE ROAD	CHARLESTON	SC	29407	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03863	301 WEST THOMAS ST.	LAKE CITY	SC	29560	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04071	733 S. IRBY ST.	FLORENCE	SC	29501	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07568	1055 RED BANK ROAD	GOOSE CREEK	SC	29445	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07384	120 NORTH LONGSTREET ST.	KINGSTREE	SC	29556	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07695	6323 SAVANNAH HWY, UNIT D	RAVENEL	SC	29470	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07654	2996 E. HWY 501	CONWAY	SC	29526	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05580	1941 N. MAIN ST.	SUMMERVILLE	SC	29486	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03113	1602 CENTRAL AVE.	SUMMERVILLE	SC	29483	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04153	2446 HUDSON RD	GREER	SC	29650	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07012	1330 DUTCH FORK RD	IRMO	SC	29063	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07396	1010 HWY 17 NORTH	NORTH MYRTLE BEACH	SC	29582	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07508	9912 DUNBARTON BOULEVARD	BARNWELL	SC	29812	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00443	1739 MAYBANK HWY	CHARLESTON	SC	29412	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05386	8523 OLD STATE ROAD, POB 730	HOLLY HILL	SC	29059	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03851	707 CHURCH STREET	CONWAY	SC	29526	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05516	1303 38TH AVE. N.	MYRTLE BEACH	SC	29577	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07016	10317 OCEAN HIGHWAY 17 SOUTH	PAWLEYS ISLAND	SC	29585	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16730	2070 SAM RITTENBERG BLVD	CHARLESTON	SC	29407	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07359	405 N. FRASER ST.	GEORGETOWN	SC	29440	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01039	59 GEORGE ST.	CHARLESTON	SC	29401	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04111	2814 N MAIN ST.	ANDERSON	SC	29621	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03861	705 ELM ST. WEST	HAMPTON	SC	29924	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04523	1638 RICHLAND AVE W	AIKEN	SC	29801-3236	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06958	9625 HWY 78	LADSON	SC	29456	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04382	1751 EAST MAIN STREET	SPARTANBURG	SC	29307	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04395	10599 DORCHESTER RD.	SUMMERVILLE	SC	29485	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03821	2310 W BOBO NEWSOM HWY	HARTSVILLE	SC	29550	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04288	2707 CELANESE RD.	ROCK HILL	SC	29732	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00528	3575 MAYBANK HIGHWAY SUITE K	JOHNS ISLAND	SC	29455	07/14/2022	10/01/2022		10/01/2022
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	CVS/PHARMACY #17847	211 KING ST	CHARLESTON	SC	29401	10/12/2022	01/01/2023	01/01/2023	01/30/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11442	877 ISLAND PARK DR, SUITE 100	CHARLESTON	SC	29492	10/12/2022	01/01/2023	01/01/2023	01/30/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11442	877 ISLAND PARK DR, SUITE 100	CHARLESTON	SC	29492	04/06/2023	07/01/2023		07/01/2023
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	CVS/PHARMACY #17847	211 KING ST	CHARLESTON	SC	29401	04/06/2023	07/01/2023	03/05/2024	04/10/2024
Contract Detail	SOUTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05531	2195 MAGNOLIA STREET	ORANGEBURG	SC	29115	04/06/2023	04/18/2023		04/18/2023
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/10/2017	04/01/2017	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-0616	2795 NORTH RD		ORANGEBURG	SC	29118	04/06/2023	04/18/2023	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-0628	9880 DORCHESTER RD		SUMMERVILLE	SC	29485	04/21/2014	07/01/2014	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-0632	1481 US HWY 17 NORTH		MT PLEASANT	SC	29464	04/21/2014	07/01/2014	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-1146	511 NO. HWY 52		MONCKS CORNER	SC	29461	04/21/2014	07/01/2014	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-1359	7400 RIVERS AVENUE		NORTH CHARLESTON	SC	29406	04/21/2014	07/01/2014	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-1748	3951 W ASHLEY CIRCLE		CHARLESTON	SC	29414	04/21/2014	07/01/2014	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-2348	1231 FOLLY ROAD		CHARLESTON	SC	29412	04/21/2014	07/01/2014	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-2928	605 ST. JAMES AVENUE		GOOSE CREEK	SC	29445	04/21/2014	07/01/2014	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-3367	4920 CENTRE POINTE DRIVE		NORTH CHARLESTON	SC	29418	04/21/2014	07/01/2014	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/06/2023	04/18/2023	03/03/2024	03/03/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/10/2017	04/01/2017	03/03/2024	03/03/2024
Contract Detail	WAL-MART STORES EAST, LP	WAL-MART PHARMACY 10-4384	3000 PROPRIETORS PLACE	MOUNT PLEASANT	SC	29466	04/21/2014	07/01/2014	03/03/2024	03/03/2024
Contract Detail	WALGREEN CO	DBA: WALGREENS # 06686	300 S KINGS HIGHWAY	MYRTLE BEACH	SC	29577	03/05/2013	04/01/2013	08/18/2021	08/20/2021
Contract Detail	WALGREEN CO	DBA: WALGREENS #09134	138 OKATIE CENTER BLVD S	OKATIE	SC	29909	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #11252	2363 BOUNDARY ST	BEAUFORT	SC	29902-3735	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS	28727 OREGON ROAD	PERRYSBURG	OH	43551	03/06/2013	04/01/2013	08/10/2015	02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01072	1120 N MAIN STREET	SUMMERVILLE	SC	29483-7326	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01073	1010 OLD BARNWELL ROAD	WEST COLUMBIA	SC	29170-3406	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04813	11 PALMETTO BAY ROAD	HILTON HEAD	SC	29928	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04980	20 HATTON PL STE 100	HILTON HEAD ISLAND	SC	29926-4205	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06073	54 OLD TROLLEY ROAD	SUMMERVILLE	SC	29485	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06074	1000 BROAD ST	SUMTER	SC	29150	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15630	907 FOLLY RD	CHARLESTON	SC	29412-3919	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06076	8395 DORCHESTER RD	NORTH CHARLESTON	SC	29418	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06077	2872 S HIGHWAY 17	MURRELLS INLET	SC	29576	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06136	4467 DEVINE STREET	COLUMBIA	SC	29205	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06137	2224 AUGUSTA ROAD	WEST COLUMBIA	SC	29169-4524	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06262	3501 FOREST DRIVE	COLUMBIA	SC	29204-4003	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06597	155 SEA ISLAND PARKWAY	BEAUFORT	SC	29907-1560	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06877	4779 HWY 501	MYRTLE BEACH	SC	29579-9444	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #06898	3701 N. KINGS HIGHWAY	MYRTLE BEACH	SC	29577	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07154	1601 CHURCH STREET	CONWAY	SC	29526-2959	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07155	1500 S IRBY STREET	FLORENCE	SC	29505-3408	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07156	1810 N HWY 17	MT PLEASANT	SC	29464-3309	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07506	1290 CHESTNUT STREET	ORANGEBURG	SC	29115-3567	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07626	2498 2ND LOOP ROAD	FLORENCE	SC	29501-6162	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07652	868 FORDING ISLAND RD	BLUFFTON	SC	29910	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07702	9998 DORCHESTER RD.	SUMMERVILLE	SC	29485-8526	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07749	852 SUNSET BLVD NORTH	SUNSET BEACH	NC	28468-4262	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07956	11 N CAUSEWAY RD	PAWLEYS ISLAND	SC	29585	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09232	2407 BROAD ST	CAMDEN	SC	29020-2342	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09276	1990 MCCRAYS MILL RD.	SUMTER	SC	29150-6185	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09284	1326 N JEFFERIES BLVD	WALTERBORO	SC	29488-2733	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09487	1223 ST ANDREWS RD	COLUMBIA	SC	29210-5821	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09542	1 SOUTH ALLIANCE DRIVE	GOOSE CREEK	SC	29445-7172	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #09738	1584 CENTRAL AVE.	SUMMERVILLE	SC	29483-5528	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09805	7412 BROAD RIVER RD	IRMO	SC	29063-9662	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09834	1098 N FRASER ST	GEORGETOWN	SC	29440-2848	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09879	1106 JOHN C CALHOUN DRIVE	ORANGEBURG	SC	29115	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10227	175 FORUM DRIVE	COLUMBIA	SC	29229-7939	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10257	395 N HWY 52	MONCKS CORNER	SC	29461-3919	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10329	901 S. 5TH ST.	HARTSVILLE	SC	29550	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10447	1210 HWY 301 NORTH	DILLON	SC	29536-2455	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11270	1861 REMOUNT RD.	NORTH CHARLESTON	SC	29406-3288	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11362	1903 S. LAKE DR.	LEXINGTON	SC	29073-7760	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11379	7801 GARNERS FERRY RD.	COLUMBIA	SC	29209	03/05/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11434	1630 RED BANK RD.	GOOSE CREEK	SC	29445	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12635	3621 SAVANNAH HWY.	JOHNS ISLAND	SC	29455	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12782	1925 ASHLEY RIVER RD.	CHARLESTON	SC	29407	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15024	7501 RIVERS AVENUE	NORTH CHARLESTON	SC	29406-4662	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15072	2903 NORTH HIGHWAY 17	MOUNT PLEASANT	SC	29466	03/06/2013	04/01/2013		02/27/2017
Contract Detail	WALGREEN CO.		DBA: WALGREENS 101 ALLIANCE PARKWAY	WILLIAMSTON	SC	29697-9103	03/06/2013	04/01/2013	08/10/2015	02/27/2017
Contract Detail	WALGREEN CO.	DBA WALGREENS #15442	389 JOHNNIE DODDS BLVD.	MOUNT PLEASANT	SC	29464	01/18/2017	04/01/2017		02/27/2017
Contract Detail	WALGREEN CO.	DBA WALGREENS #15512	380 KING ST.	CHARLESTON	SC	29401	01/18/2017	04/01/2017		02/27/2017
Contract Detail	WALGREEN CO.	WALGREENS #18147	261 CALHOUN ST	CHARLESTON	SC	29401	01/15/2021	04/01/2021		04/01/2021
Contract Detail	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21191	200 RUTLEDGE AVE	CHARLESTON	SC	29403-5848	01/15/2021	04/01/2021		04/01/2021
Contract Detail	WALGREEN CO.	WALGREENS #17043	1115 OLD TOWNE RD	CHARLESTON	SC	29407	01/15/2021	04/01/2021		04/01/2021
Contract Detail	WALGREEN CO.	WALGREENS #18351	600 SAINT JAMES AVE	GOOSE CREEK	SC	29445	07/15/2022	10/01/2022		10/01/2022
Contract Detail	WALGREEN CO.	COMMUNITY A WALGREENS PHARMACY #15304	1874 PIEDMONT AVE NE STE 100A	ATLANTA	GA	30324	10/12/2022	01/01/2023		01/01/2023
Contract Detail	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	07/10/2023	10/01/2023		10/01/2023
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/07/2013	07/01/2013	07/20/2015	02/27/2017
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/07/2013	07/01/2013	07/20/2015	02/27/2017
Contract Detail	WALGREENS OF NORTH CAROLINA INC.	COMMUNITY, A WALGREENS PHARMACY #16313	2816 ERWIN ROAD SUITE 105	DURHAM	NC	27705	01/18/2017	04/01/2017		02/27/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/15/2016	07/01/2016		02/27/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/15/2016	07/01/2016	10/01/2021	10/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/15/2016	07/01/2016		02/27/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/15/2016	07/01/2016		02/27/2017
Contract Detail	WALMART PHARMACY 10-3724	332 STONE WALL JACKSON BLVD		ORANGEBURG	SC	29115	04/06/2023	04/18/2023	03/03/2024	03/03/2024
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/06/2023	07/01/2023	03/03/2024	03/03/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH420004AA	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Hollings BMT	86 Jonathan Lucas Street	Charleston	SC	Active
DSH420004AB	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	135 Cannon Women's Health Pre-Natal Wellness	135 Cannon Street	Charleston	SC	Terminated
DSH420004AC	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Women's Health Faculty Practice	135 Cannon Street	Charleston	SC	Active
DSH420004AD	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Women's Health Resident Practice	135 Cannon Street	Charleston	SC	Terminated
DSH420004AE	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	135 Cannon Women's Health Ultrasound Gen	135 Cannon Street	Charleston	SC	Active
DSH420004AF	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Family Medicine / Ellis Oaks	650 Ellis Oaks Avenue	Charleston	SC	Active
DSH420004AG	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RT 1 Children's Specialty	135 Rutledge Avenue	Charleston	SC	Terminated
DSH420004AH	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RT Children's Day Services	135 Rutledge Avenue	Charleston	SC	Active
DSH420004AJ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RT Children's Endo /DEVP/GEN	135 Rutledge Avenue	Charleston	SC	Active
DSH420004AK	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RT 4 Children's Specialty	135 Rutledge Avenue	Charleston	SC	Terminated
DSH420004AL	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Children's Hem Onc	135 Rutledge Avenue	Charleston	SC	Active
DSH420004AM	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RT Pediatric Primary Care	135 Rutledge Avenue	Charleston	SC	Active
DSH420004AN	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Ambulatory Procedure Ctr East Cooper	735 Johnnie Dodds Blvd.	Mt. Pleasant	SC	Terminated
DSH420004AP	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Maxillofacial	135 Rutledge Avenue	Charleston	SC	Active
DSH420004AQ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Dermatology	135 Rutledge Avenue	Charleston	SC	Active
DSH420004AR	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Dermatology-Oncology	135 Rutledge Avenue	Charleston	SC	Terminated
DSH420004AS	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Neurosurgery and Spine	135 Rutledge Avenue	Charleston	SC	Terminated
DSH420004AT	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Pain Management	135 Rutledge Avenue	Charleston	SC	Active
DSH420004AU	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Transplant & Nephrology	135 Rutledge Avenue	Charleston	SC	Active
DSH420004AV	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	University Internal Medicine	135 Rutledge Avenue	Charleston	SC	Active
DSH420004AW	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Endocrinology	135 Rutledge Avenue	Charleston	SC	Active
DSH420004AX	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Surgical Centers	135 Rutledge Avenue	Charleston	SC	Terminated
DSH420004AY	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Infectious Diseases	135 Rutledge Avenue	Charleston	SC	Terminated
DSH420004AZ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Urology	135 Rutledge Avenue	Charleston	SC	Active
DSH420004BA	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Pulmonary	135 Rutledge Avenue	Charleston	SC	Active
DSH420004BB	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Rheumatology	135 Rutledge Avenue	Charleston	SC	Active
DSH420004BC	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower ENT & Reconstructive Surg	135 Rutledge Avenue	Charleston	SC	Active
DSH420004BD	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rutledge Tower Neurology	135 Rutledge Avenue	Charleston	SC	Active
DSH420004BE	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RT Neuromuscular Clinic	135 Rutledge Avenue	Charleston	SC	Terminated
DSH420004BF	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RT Sinus Center	135 Rutledge Avenue	Charleston	SC	Active
DSH420004BG	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Children's Hospital After Hours Clinic	2750 Dantzler Drive	N. Charleston	SC	Active
DSH420004BH	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Chest Pain Center	25 Courtenay Drive	Charleston	SC	Active
DSH420004BJ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART - Card/Vasc/Surg	25 Courtenay Drive	Charleston	SC	Active
DSH420004BK	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	East Cooper Radiation Oncology	1180 Hospital Dr	Mount Pleasant	SC	Active
DSH420004BL	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	North Star (Psych Outpt)	67 President St	Charleston	SC	Terminated
DSH420004BM	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	East Cooper Occupational Therapy	1600 Midtown Avenue	Mount Pleasant	SC	Terminated
DSH420004BN	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Speech Pathology	1600 Midtown Avenue	Mount Pleasant	SC	Active
DSH420004BP	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RT 7 Ortho	135 Rutledge Avenue	CHARLESTON	SC	Active
DSH420004BQ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Epilepsy Center	135 Rutledge Avenue	Charleston	SC	Terminated
DSH420004BR	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Outpatient Cardiac Rehab	122 Bee St., Suite 201	Charleston	SC	Active
DSH420004BS	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Foster Care Clinic	135 Rutledge Avenue	Charleston	SC	Active
DSH420004BT	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CDAP Outpatient Program	67 President St.	Charleston	SC	Active
DSH420004BU	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Psych - Adult PHP/IOP	67 President St.	Charleston	SC	Active
DSH420004BV	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Mood Disorders Clinic	67 President St.	Charleston	SC	Active
DSH420004BW	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RT Benign Hematology	135 Rutledge Ave	Charleston	SC	Active
DSH420004BX	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CH After Hrs & Specialty Clinics MP	2705 N Hwy 17	Mount Pleasant	SC	Active
DSH420004BY	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CH After Hrs & Spec Clinics S'Ville	4330 Ladson Rd	Summerville	SC	Active
DSH420004BZ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Sleep Laboratory	4480 Leeds Place West	North Charleston	SC	Active
DSH420004CA	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART PACU	25 Courtenay Drive	Charleston	SC	Active
DSH420004CB	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Amb PACU	135 Rutledge Ave	Charleston	SC	Active
DSH420004CC	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Speech Language Pathology	25 Courtenay Dr.	Charleston	SC	Active
DSH420004CD	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Adult Heart Cath	25 Courtenay Dr.	Charleston	SC	Active
DSH420004CE	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Device Monitoring Program	25 Courtenay Dr.	Charleston	SC	Active
DSH420004CF	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Anesthesia	25 Courtenay Dr	Charleston	SC	Active
DSH420004CG	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Adult Respiratory Therapy	25 Courtenay Dr	Charleston	SC	Active
DSH420004CH	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Physical Therapy	25 Courtenay Dr	Charleston	SC	Active
DSH420004CJ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Occupational Therapy	25 Courtenay Dr.	Charleston	SC	Active
DSH420004CK	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Rad Nuc Med	25 Courtenay Dr	Charleston	SC	Active
DSH420004CL	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Vascular Lab	25 Courtenay Dr.	Charleston	SC	Active
DSH420004CM	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Acute Directional Unit	25 Courtenay Dr.	Charleston	SC	Terminated
DSH420004CN	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Pneumogram Monitor	135 Rutledge Ave	Charleston	SC	Active
DSH420004CP	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Anesthesia Ambulatory OR	135 Rutledge Ave	Charleston	SC	Terminated
DSH420004CQ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Interventional Radiology	25 Courtenay Dr	Charleston	SC	Active
DSH420004CR	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rad Peds After Hours Clinc N Area	2750 Dantzler Dr.	North Charleston	SC	Terminated
DSH420004CS	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Seinsheimer HVC Education	25 Courtenay Dr	Charleston	SC	Terminated
DSH420004CT	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Ch After Hrs Radiology MP	2705 Highway 17	Mount Pleasant	SC	Active
DSH420004CU	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Family Medicine RT	135 Rutledge Avenue	Charleston	SC	Active
DSH420004CV	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Radiation Oncology	86 Jonathan Lucas Drive	Charleston	SC	Active
DSH420004CW	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Rad After Hrs Clinic Sville - Radiology	4330 Ladson Road	Summerville	SC	Active
DSH420004CX	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Outpatient Ambulatory Care - Amb care clinics	135 Rutledge Ave	Charleston	SC	Terminated
DSH420004CY	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Heart & Vascular 4E (ART)	25 Courtenay Dr	Charleston	SC	Active
DSH420004CZ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Cardiac Acute Care 5E (ART)	25 Courtenay Dr	Charleston	SC	Active
DSH420004DA	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation ASHLEY RIVER TOWER - ART 5W Hematology Oncology	25 Courtenay Dr	Charleston	SC	Terminated
DSH420004DB	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MSICU (Medical Surgical ICU)	25 Courtenay Dr	Charleston	SC	Active
DSH420004DC	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART 3West Acute Cardiology	25 Courtenay Dr	Charleston	SC	Active
DSH420004DD	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Psychiatry Unit Observation - Geropsychiatry - Senior Care Unit	67 President St.	Charleston	SC	Terminated
DSH420004DE	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation ASHLEY RIVER TOWER - ART DDC 6 East	25 Courtenay Dr	Charleston	SC	Active
DSH420004DF	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation ASHLEY RIVER TOWER - ART Holding Peri Anesthesia	25 Courtenay Dr	Charleston	SC	Terminated
DSH420004DG	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation ASHLEY RIVER TOWER - ART 5W Specialty (DDC)	25 Courtenay Dr	Charleston	SC	Active
DSH420004DH	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation ASHLEY RIVER TOWER - ART Cardiac Care Unit (4West)	25 Courtenay Dr	Charleston	SC	Active
DSH420004DJ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Psychiatry Unit Observation - Youth Psych - Inpt	67 President St.	Charleston	SC	Active
DSH420004DK	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation ASHLEY RIVER TOWER - ART DDC 6 West	25 Courtenay Dr	Charleston	SC	Active
DSH420004DL	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation PC ICU (Ped Cardiothoracic) - PC ICU	167 Ashley Ave.	Charleston	SC	Active
DSH420004DM	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Labor & Delivery - Labor & Delivery	167 Ashley Ave	Charleston	SC	Terminated
DSH420004DN	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Psych Pain Rehabilitation Center - Psych Pain Rehabilitation Center	67 President St	Charleston	SC	Active
DSH420004DP	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART EKG - ART EKG	25 Courtenay Dr	Charleston	SC	Active
DSH420004DQ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RT Facial Plastics Recnst Surg - RT Facial Plastics Recnst Surg	135 Rutledge Ave	Charleston	SC	Active
DSH420004DR	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Pediatric Cardiology Clinic - Pediatric Cardiology Clinic	135 Rutledge Ave	Charleston	SC	Terminated
DSH420004DS	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation 8CHF Pediatric ICU - 8CHF Pediatric ICU	167 Ashley Ave	Charleston	SC	Active
DSH420004DT	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Pediatric Emergency Services - Pediatric Emergency Services	167 Ashley Ave.	Charleston	SC	Terminated
DSH420004DU	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Pediatric Same Day Cath Room - Pediatric Same Day Cath Room	167 Ashley Ave	Charleston	SC	Terminated
DSH420004DV	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation 7A Infant Care Unit - 7A Infant Care Unit	167 Ashley Ave.	Charleston	SC	Terminated
DSH420004DW	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation CDAP Inpatient Program - CDAP Inpatient Program	67 President St.	Charleston	SC	Terminated
DSH420004DX	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation Postpartum GYN Services - Postpartum GYN Services	167 Ashley Ave	Charleston	SC	Terminated
DSH420004DY	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Adult ECHO - ART Adult ECHO	25 Courtenay Dr	Charleston	SC	Active
DSH420004DZ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation Pediatric Burn Program (CAN Program) - Pediatric Burn Program	167 Ashley Ave	Charleston	SC	Active
DSH420004EA	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation Peds Intermediate Care Unit - Peds Intermediate Care Unit	167 Ashley Ave	Charleston	SC	Active
DSH420004EB	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	HCC-Scrambler - HCC-Scrambler	86 Jonathan Lucas St	Charleston	SC	Active
DSH420004EC	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation 7 East Pediatric Surgery - 7 East Pediatric Surgery	167 Ashley Ave	Charleston	SC	Active
DSH420004ED	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation Pediatric Procedure Area - Pediatric Procedure Area	167 Ashley Ave	Charleston	SC	Terminated
DSH420004EE	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Pediatric Respiratory Therapy - Pediatric Respiratory Therapy	167 Ashley Ave	Charleston	SC	Active
DSH420004EF	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation Ped Sub-specialty - Ped Sub-specialty	167 Ashley Ave.	Charleston	SC	Terminated
DSH420004EG	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation Antepartum GYN Services - Antepartum GYN Services	167 Ashley Ave.	Charleston	SC	Terminated
DSH420004EJ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation 8D Pediatric Cardiac Unit - 8D Pediatric Cardiac Unit	167 Ashley Ave	Charleston	SC	Active
DSH420004EK	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Observation ART 7West - ART 7 West	25 Courtenay Dr.	Charleston	SC	Active
DSH420004EL	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Eating Disorder Program (Child Clinic) - Eating Disorder Program (Child Clinic)	135 Rutledge Ave	Charleston	SC	Active
DSH420004EM	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Childrens Therapy Center - MUSC Childrens Therapy Center	167 Ashley Ave	Charleston	SC	Active
DSH420004EN	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	OR Services - Operating Room	167 Ashley Ave	Charleston	SC	Active
DSH420004EP	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	PACU - Recovery Room	167 Ashley Ave.	Charleston	SC	Active
DSH420004EQ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC-Peds Ophthalmology	2250 Mall Dr.	North Charleston	SC	Active
DSH420004ER	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC-Urgent Care	2250 Mall Dr.	North Charleston	SC	Active
DSH420004ES	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC-Pre/Post	2250 Mall Drive	North Charleston	SC	Active
DSH420004ET	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC-Radiology MRI	2250 Mall Dr.	North Charleston	SC	Active
DSH420004EU	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC- OR	2250 Mall Drive	North Charleston	SC	Terminated
DSH420004EV	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC- Infusion	2250 Mall Dr.	North Charleston	SC	Active
DSH420004EW	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC-Anesthesia	2250 Mall Dr.	North Charleston	SC	Terminated
DSH420004EX	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC-2nd Floor Specialty Clinics	2250 Mall Dr.	North Charleston	SC	Active
DSH420004EY	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC- Radiology CT	2250 Mall Dr.	North Charleston	SC	Active
DSH420004EZ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC- Radiology Ultrasound	2250 Mall Dr.	North Charleston	SC	Terminated
DSH420004FA	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC Children's Health R. Keith Summey Medical Pavilion - CAC- Radiology Diagnostic	2250 Mall Dr.	North Charleston	SC	Active
DSH420004FB	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Radiology - Diagnositc - CC - CT	2250 Mall Drive	North Charleston	SC	Active
DSH420004FC	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Radiology - Diagnostic - CC - MRI	2250 Mall Drive	North Charleston	SC	Active
DSH420004FD	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	AMS Care Clinics - CH 1 Outpatient Services	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FE	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Recovery Rooms - CH 3 Pre & Post OP	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FF	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Operating Rooms - CH 3 OR	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FG	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Heart Catheterization - CH 3 Cath Lab	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FH	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Labor & Delivery Room - WP 4 Labor & Delivery	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FJ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Respiratory Therapy - Pulmonary Function Testing Lab	135 Rutledge Avenue	Charleston	SC	Active
DSH420004FK	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Emergency - Outpatient Beds Only - SJCH Children's Emergency Dept	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FL	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	SJCH Anesthesia - SJCH Anesthesia	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FM	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ED 1 West (Adult ED) - ED 1 West (Adult ED)	96 Jonathan Lucas Street	Charleston	SC	Active
DSH420004FN	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Peds Derm RT3 - Peds Derm RT3	135 Rutledge Avenue 3rd floor	Charleston	SC	Active
DSH420004FP	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	SJCH 3 Cardiac Prep recovery - SJCH 3 Cardiac Prep recovery	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FQ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	SJCH OB Anesthesia - SJCH OB Anesthesia	10 McClennan Banks	Charleston	SC	Active
DSH420004FR	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	SJCH 2 Endoscopy - SJCH 2 Endoscopy	10 McClennan Banks	Charleston	SC	Active
DSH420004FS	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Pulm Elms - Pulm Elms	2575 Elms Center Rd	North Charleston	SC	Active
DSH420004FT	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	SJCH 3 Heart Center - SJCH 3 Heart Center	10 McClennan Banks	Charleston	SC	Active
DSH420004FU	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	SJCH 2 Burn Center - SJCH 2 Burn Center	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FV	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	SJCH 10 Cancer Center - SJCH 10 Cancer Center	10 McClennan Banks	Charleston	SC	Active
DSH420004FW	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	SJCH 9 Acute Care - SJCH 9 Acute Care	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FX	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	SJCH 8 Acute Care - SJCH 8 Acute Care	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004FY	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - Santee Wellness - Santee Healthplex/Lab/Xray - CC004825	3000 Saint Matthews Road	Orangeburg	SC	Terminated
DSH420004FZ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - Dietary General - Dietary - CC004852	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GA	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - Recovery Room - Recovery Room - CC004760	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GB	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG MSSU (CC004756)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GC	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG CCU (CC004750)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GD	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG DAI (CC004819)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GE	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG ENDOSCOPY (CC004761)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GF	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - Emergency Room	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GG	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG CARD DIAG	1175 Cook Rd	Orangeburg	SC	Active
DSH420004GH	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG RAD MAMMO (CC004775)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GJ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - Cardiac Rehab	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GK	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MCP - ORBG - Vascular Lab - Radiology Diagnostics - CC004796	3000 Street Matthews Road	Orangeburg	SC	Terminated
DSH420004GL	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG RESPIRATORY/PFT/EEG LAB (CC004811)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GM	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG MAIN OR (CC004759)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GN	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - OB 2 West - OB 2 West - CC004753	3000 Street Matthews Road	Orangeburg	SC	Terminated
DSH420004GP	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG DIALYSIS (CC004817)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GQ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG INFUSION (CC004900)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GR	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG 3E MED/SURG (CC004746)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GS	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - Healthplex - RMCSC Therapies - CC004810	3000 Street Matthews Road	Orangeburg	SC	Terminated
DSH420004GT	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG 4E REHAB (CC004827)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GU	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG 4W MED/SURG (CC004748)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GV	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG LAB (CC004778)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GW	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG VEIN CLINIC (CC004801)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GX	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG ICU (CC004751)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GY	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG NURSERY (CC004754)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004GZ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG 2E MED/SURG (CC004749)	3000 Saint Matthews Road	Orangeburg	SC	Terminated
DSH420004L	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART GI Surgery Bariatric Clinic	25 Courtenay Drive	Charleston	SC	Active
DSH420004LA	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG 3W MED/SURG (CC004747)	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004LB	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MCP - ORBG - Cardiology (Dr. Hutto & Dr. King) - Cardiology - CC004838	2664 Saint Matthews Road	Orangeburg	SC	Terminated
DSH420004LC	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - BBEMC Radiology	1524 Barnwell Hwy	Denmark	SC	Active
DSH420004LD	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MCP - ORBG - Cardiology (Dr. Krzyston) - CC004836	1175 Cook Road	Orangeburg	SC	Terminated
DSH420004LE	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MCP - ORBG - Cardiology (Dr. Castro) - Cardiology - CC004837	1137 Cook Road	Orangeburg	SC	Terminated
DSH420004LF	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MUSC-ORBG RAD ONC (CC004782)	1161 Cook Road	Orangeburg	SC	Active
DSH420004LG	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Pharmacotherapy - Ambulatory Clinic (Main) (CC000602) - Pharmacotherapy	67 President St	Charleston	SC	Active
DSH420004LH	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Lab - Clinical Psychiatry (IOP)(CC000480) - Lab	67 President Street	Charleston	SC	Active
DSH420004LJ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Burn Clinic (Main)(CC000299) - Psychiatry	67 President St	Charleston	SC	Active
DSH420004LK	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS- Pharmacotherapy Ambulatory Clinic - ART - 1st floor	25 Courtenay Drive	Charleston	SC	Active
DSH420004LL	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Adult Sickle Cell (RT) - MUSC HEALTH RENA N. GRANT SICKLE CELL CENTER	135 Rutledge Ave	Charleston	SC	Active
DSH420004LM	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CC000420 CHS - Electrocardio - Pediatric (SJCH) - Peds EKG / Stress Test - Summey Medical Pavilion	2250 Mall Drive	North Charleston	SC	Active
DSH420004LN	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Diagnostic Radiology (SJCH) - Radiology	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004LP	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Head & Neck Clinic (RT) - Wellin Head and Neck Tumor Center at Rutledge Tower	135 Rutledge Avenue	Charleston	SC	Active
DSH420004LQ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Ambulatory Preop Clinic (RT) - Recovery Room	135 Rutledge Avenue	Charleston	SC	Active
DSH420004LR	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - CAT Scan (SJCH) - Radiology	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004LS	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Pre / Post - East Cooper (Offsite) - STORM EYE CHUCK DAWLEY	1106 Chuck Dawley Blvd	Mount Pleasant	SC	Active
DSH420004LT	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Therapy - Occupational / Physical Therapy - PT/OT CHUCK DAWLEY	1106 Chuck Dawley Blvd	Mount Pleasant	SC	Active
DSH420004LU	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - Cardiology - NUC STRESS	3000 Saint Matthews Rd	Orangeburg	SC	Active
DSH420004LV	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Interventional Radiology (SJCH) - Radiology	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004LW	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Diagnostic Radiology (RT) - Diagnostic Imaging	135 Rutledge Avenue	Charleston	SC	Active
DSH420004LX	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	MED ONC ORBG MABRY - Oncology	1161 Cook Rd	Orangeburg	SC	Active
DSH420004LY	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Anesthesia - East Cooper (Offsite) - Anesthesia	1106 Chuck Dawley Blvd	Mount Pleasant	SC	Active
DSH420004LZ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - ECHO - Pediatric (SJCH) - Pediatric Echocardiogram - Summey Medical Pavilion	2250 Mall Drive	North Charleston	SC	Active
DSH420004M	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Ambulatory OR	135 Rutledge Avenue	Charleston	SC	Active
DSH420004MA	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - COVID Infusion - Citadel Mall	2060 Sam Rittenberg Blvd	Charleston	SC	Active
DSH420004MB	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	RAD ONC GENERAL ORBG - Oncology	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004MC	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - OR - Ambulatory Service Center - OR CHUCK DAWLEY	1106 Chuck Dawley Blvd	Mount Pleasant	SC	Active
DSH420004MD	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Ultrasound - SMP - Ultrasound Imaging	2250 Mall Drive	North Charleston	SC	Active
DSH420004ME	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CC000431 CHS - Endoscopy - West Campus (Offsite) - WEST CAMPUS ENDOSCOPY	2060 Sam Rittenberg Blvd	Charleston	SC	Active
DSH420004MF	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Chuck Dawley - Endoscopy - Endoscopy	1106 Chuck Dawley Blvd	Mount Pleasant	SC	Active
DSH420004MG	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Burn Clinic (Main) - Burn Center	135 Rutledge Ave	Charleston	SC	Active
DSH420004MH	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - CAT Scan (RT) - Radiology	135 Rutledge Ave	Charleston	SC	Active
DSH420004MJ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Neurology (RT) - Neurology,Neurosurgery	165 Ashley Ave	Charleston	SC	Active
DSH420004MK	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Neuro Rehab Institute - PT/OT/OT NEURO REHAB INSTITUTE	MUSC Health Neurologic Rehabilitation Institute	Charleston	SC	Active
DSH420004ML	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - MRI (SJCH) - Radiology	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004MM	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Advanced Fetal Care Center (SJCH) - FETAL CARE SJCH1	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004MN	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Therapy - Speech SJCH - Physical / Occupatio/Speech Cost Center	10 McClennan Banks Drive	Charleston	SC	Active
DSH420004MP	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - MRI (RT) - Rutledge Tower MR Imaging	135 Rutledge Avenue	Charleston	SC	Active
DSH420004MQ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - EMG IOM & Neurovascular (Main) - Neurophysiology Lab RT1	135 Rutledge Ave	Charleston	SC	Active
DSH420004MR	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS- Pharmacotherapy Ambulatory Clinic HEC2 - East Cooper	1600 Midtown Avenue	Mount Pleasant	SC	Active
DSH420004MS	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS- Pharmacotherapy Ambulatory Clinic - RT Internal Medicine	135 Rutledge Avenue	Charleston	SC	Active
DSH420004MT	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS- Pharmacotherapy Ambulatory Clinic - Fam Med Bee St	30 Bee St	Charleston	SC	Active
DSH420004MU	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS- Pharmacotherapy Ambulatory Clinic - HCC1	86 Jonathan Lucas Street	Charleston	SC	Active
DSH420004MV	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS- Pharmacotherapy Ambulatory Clinic - Health West	2060 Sam Rittenberg Blvd	Charleston	SC	Active
DSH420004MW	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS- Pharmacotherapy Ambulatory Clinic - Fam Med James Island	650 Ellis Oak Drive	Charleston	SC	Active
DSH420004MX	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - Radiology Dept - Radiology	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004MY	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - CT Scan - Radiology	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004MZ	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - PET - Radiology	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004N	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART OR	25 Courtenay Drive	Charleston	SC	Active
DSH420004NA	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - IR Special Procedures - Radiology	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004NB	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - MRI - Radiology	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004NC	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - Nuclear Medicine - Radiology	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004ND	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ORBG - Cardiac Cath Lab - Cardiology	3000 Saint Matthews Road	Orangeburg	SC	Active
DSH420004NE	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - OR - West Campus (Offsite) - Health West	2060 Sam Rittenberg Blvd	Charleston	SC	Active
DSH420004NF	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Pre / Post - West Campus (Offsite) - Health West	2060 Sam Rittenberg Blvd	Charleston	SC	Active
DSH420004NG	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	CHS - Pharmacotherapy Clinic - MUSC Elms Medical Office Building	2575 Elms Center Rd	NORTH CHARLESTON	SC	Active
DSH420004P	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Pre/Post Anes-Amb OR Recovery	135 Rutledge Avenue	Charleston	SC	Terminated
DSH420004Q	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	North Area Infusion	2575 Elms Center Rd	North Charleston	SC	Active
DSH420004R	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	James Island OT & PT Clinic	650 Ellis Oak Drive	Charleston	SC	Terminated
DSH420004S	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART HVC Prep & Recovery (Amb Cardiology)	25 Courtenay Drive	Charleston	SC	Active
DSH420004T	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Pediatric GI Clinic	135 Rutledge Avenue	Charleston	SC	Terminated
DSH420004U	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART Endoscopy	25 Courtenay Drive	Charleston	SC	Active
DSH420004V	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	DDC Operations (GI Clinic)	25 Courtenay Drive	Charleston	SC	Terminated
DSH420004W	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	ART GI Clinic 2nd Floor	25 Courtenay Drive	Charleston	SC	Active
DSH420004X	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	STAR - Ladson (Psy)	4330 Ladson Rd.	Ladson	SC	Active
DSH420004Y	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Hollings Clinics	86 Jonathan Lucas Street	Charleston	SC	Active
DSH420004Z	Child	DSH	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	Hollings Chemotherapy	86 Jonathan Lucas Street	Charleston	SC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Change Request	003162150A (GA)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	7Z1019 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	7Z1044 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	744042 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	797103 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	731027 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	713497 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	797506 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	708630 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	00302118 (NC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	749192 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	AL0971 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	BL0971 (SC)		3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		178277	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		160808	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		178277	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		160808	3/5/2025 8:12 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1952632234 (SC)		3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1710683354 (SC)		3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508563727 (SC)		3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1033120837 (SC)		3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1669171740 (SC)		3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1154020147 (SC)		3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1770280299	3/5/2025 8:12 AM
Medicaid Billing	NPI: State	Insert	Change Request		NC	3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1659435840	3/5/2025 8:12 AM
Medicaid Billing	NPI: State	Insert	Change Request		NC	3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1073605879	3/5/2025 8:12 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1770280299	3/5/2025 8:12 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	3/5/2025 8:12 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1659435840	3/5/2025 8:12 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	3/5/2025 8:12 AM
Addresses	Shipping Address	Update	Change Request	MUSC Children's Hospital Pharmacy 10 McClennan Banks Dr. Charleston, SC 29425	MUSC Children's Hospital Pharmacy 10 McClennan Banks Dr. Suite 2136 Charleston, SC 29425	2/23/2025 1:59 PM
Addresses	Shipping Address	Insert	Change Request		MUSC 165 Ashley Ave EH 208 Charleston, SC 49425	1/22/2025 12:29 PM
Addresses	Shipping Address	Insert	Change Request		MUSC 169 Ashley Ave MH 208 Room 161 Charleston, SC 29425	1/22/2025 12:29 PM
Details	Last Recertification Date	Update	Recertification	8/14/2023 1:39:54 PM	8/19/2024 12:49:35 PM	8/19/2024 12:49 PM
Contacts	Primary Contact	Update	Group Change Request	Kushner, Gail M Director, 340B MEDICAL UNIVERSITY HOSPITAL AUTHORITY 8439852371	Brown, Sharelle Executive System Director Pharmacy Business and Finance MUSC Health 2483968085	7/12/2024 6:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/24/2024 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		AL0971	6/24/2024 8:44 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	6/24/2024 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/24/2024 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		BL0971	6/24/2024 8:44 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	6/24/2024 8:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/24/2024 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		178277	6/24/2024 8:44 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	6/24/2024 8:44 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1669171740	6/24/2024 8:44 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	6/24/2024 8:44 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1154020147	6/24/2024 8:44 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	6/24/2024 8:44 AM
Addresses	Shipping Address	Update	Change Request	MUSC Pharmacy Distribution Center 7771 Palmetto Commerce Parkway Room 401 North Charleston, SC 29420	Medical University of South Carolina (MUSC) Consolidated Service Center 7771 Palmetto Commerce Parkway Suite 401 North Charleston, SC 29420	5/8/2024 1:01 PM
Addresses	Billing Address	Update	Group Change Request	MEDICAL UNIVERSITY HOSPITAL AUTHORITY 1 POSTON ROAD PARKSHORE 103 CHARLESTON, SC 29425	MEDICAL UNIVERSITY HOSPITAL AUTHORITY PO Box 31244 Salt Lake City, UT 84131	3/25/2024 1:16 PM
Addresses	Shipping Address	Update	Change Request	MUSC Pharmacy Distribution Center 169 Ashley Avenue, Room 161 Charleston, SC 29425	MUSC Pharmacy Distribution Center 7771 Palmetto Commerce Parkway Room 401 North Charleston, SC 29420	3/6/2024 9:02 AM
Addresses	Shipping Address	Update	Change Request	MUSC- Mail Order Pharmacy 2070 Sam Rittenberg Blvd , Suite A116 Charleston, SC 29407	MUSC- Mail Order Pharmacy 7771 Palmetto Commerce Parkway Room 404 North Charleston, SC 29420	3/6/2024 9:02 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508563727	1/16/2024 9:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	1/16/2024 9:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1033120837	1/16/2024 9:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	1/16/2024 9:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1073605879	1/16/2024 9:34 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	1/16/2024 9:34 AM
Addresses	Billing Address	Insert	Change Request		MEDICAL UNIVERSITY HOSPITAL AUTHORITY 1 POSTON ROAD PARKSHORE 103 CHARLESTON, SC 29425	10/9/2023 8:24 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 2:40:21 PM	8/14/2023 1:39:54 PM	8/14/2023 1:39 PM
Contacts	Primary Contact	Update	Profile Change Request	Kushner, Gail Marcia Director, 340B MEDICAL UNIVERSITY HOSPITAL AUTHORITY 8439852371	Kushner, Gail M Director, 340B MEDICAL UNIVERSITY HOSPITAL AUTHORITY 8439852371	7/3/2023 7:46 AM
Addresses	Shipping Address	Update	Change Request	MUSC Health Orangeburg Hospital Pharmacy 3000 Saint Matthews Rd Ground floor Orangeburg, SC 29118-1442	MUSC Health Orangeburg Hospital Pharmacy 3000 Saint Matthews Rd Orangeburg, SC 29118-1442	6/9/2023 10:55 AM
Addresses	Shipping Address	Update	Change Request	MUSC HEALTH H.F.Mabry Cancer Center Pharmacy 1171 Cook Rd Orangeburg, SC 29118	MUSC HEALTH H.F.Mabry Cancer Center Pharmacy 1161 Cook Rd Orangeburg, SC 29118	6/9/2023 10:55 AM
Addresses	Shipping Address	Insert	Change Request		MUSC Health Orangeburg Hospital Pharmacy 3000 Saint Matthews Rd Ground floor Orangeburg, SC 29118-1442	6/8/2023 2:00 PM
Addresses	Shipping Address	Insert	Change Request		MUSC HEALTH H.F.Mabry Cancer Center Pharmacy 1171 Cook Rd Orangeburg, SC 29118	6/8/2023 2:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/13/2023 2:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		749192	4/13/2023 2:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	4/13/2023 2:54 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1952632234	4/11/2023 10:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	4/11/2023 10:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1710683354	4/11/2023 10:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	4/11/2023 10:54 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1770280299	4/11/2023 10:54 AM
Medicaid Billing	NPI: State	Insert	Change Request		SC	4/11/2023 10:54 AM
Contacts	Primary Contact	Update	Profile Change Request	Kushner, Gail Marcia Director, 340B MEDICAL UNIVERSITY HOSPITAL AUTHORITY 2038584254	Kushner, Gail Marcia Director, 340B MEDICAL UNIVERSITY HOSPITAL AUTHORITY 8439852371	4/1/2023 12:14 PM
Addresses	Shipping Address	Update	Change Request	MUSC CHILDRENS HLTH MED PAV PHARM 2250 MALL DR CHARLESTON, SC 29406	MUSC CHILDRENS HLTH MED PAV PHARM 2250 MALL DR NORTH CHARLESTON, SC 29406	3/20/2023 6:36 AM
Addresses	Shipping Address	Update	Change Request	MUSC CHILDRENS HLTH MED PAVIL INFUS 2250 MALL DR NORTH CHARLESTON, SC 29425	MUSC CHILDRENS HLTH MED PAVIL INFUS 2250 MALL DR NORTH CHARLESTON, SC 29406	3/20/2023 6:36 AM
Addresses	Shipping Address	Update	Change Request	MUSC- Mail Order Pharmacy 230 Albemarle Rd WH 126 Charleston, SC 29407	MUSC- Mail Order Pharmacy 2070 Sam Rittenberg Blvd , Suite A116 Charleston, SC 29407	3/20/2023 6:36 AM
Addresses	Shipping Address	Delete	Change Request	MUSC GIVEN-IN-CLINIC 135 Rutledge Avenue Charleston, SC 29425		3/20/2023 6:36 AM
Details	Last Recertification Date	Update	Recertification	8/20/2021 1:44:22 PM	8/26/2022 2:40:21 PM	8/26/2022 2:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1073605879 (NC)		7/12/2022 3:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/12/2022 3:27 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00302118	7/12/2022 3:27 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	7/12/2022 3:27 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1073605879	7/12/2022 3:27 PM
Medicaid Billing	NPI: State	Insert	Change Request		NC	7/12/2022 3:27 PM
Contacts	Primary Contact	Update	Change Request	Crowley, Kelly Director MUSC 8437921009	Kushner, Gail Marcia Director, 340B MEDICAL UNIVERSITY HOSPITAL AUTHORITY 2038584254	7/12/2022 8:28 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/20/2022 11:34 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		708630	5/20/2022 11:34 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	5/20/2022 11:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/4/2022 12:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7Z1019	5/4/2022 12:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	5/4/2022 12:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/4/2022 12:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7Z1044	5/4/2022 12:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	5/4/2022 12:09 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1083171185	5/4/2022 12:09 PM
Medicaid Billing	NPI: State	Insert	Change Request		SC	5/4/2022 12:09 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1639737349	5/4/2022 12:09 PM
Medicaid Billing	NPI: State	Insert	Change Request		SC	5/4/2022 12:09 PM
Contacts	Primary Contact	Update	Change Request	Knudsen, Alan 340B Manager Medical University Hospital Authority 8437925691	Crowley, Kelly Director MUSC 8437921009	12/13/2021 1:22 PM
Addresses	Shipping Address	Insert	Change Request		MUSC - Family Medicine Pharmacy 650 Ellis Oak Ave Rm 119 Charleston, SC 29412-3089	11/29/2021 2:14 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1295840148	11/29/2021 2:14 PM
Medicaid Billing	NPI: State	Insert	Change Request		SC	11/29/2021 2:14 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 11:55:08 AM	8/20/2021 1:44:22 PM	8/20/2021 1:44 PM
Addresses	Shipping Address	Insert	Change Request		MUSC - University Hospital Pharmacy 169 Ashley Avenue Room# 462 Charleston, SC 29425	6/8/2021 1:36 PM
Addresses	Shipping Address	Insert	Change Request		MUSC Pharmacy Distribution Center 169 Ashley Avenue, Room 161 Charleston, SC 29425	3/29/2021 11:34 AM
Contacts	Primary Contact	Update	Change Request	Mills, Jason Pharmacy Manager Medical University Hospital Authority 8437927354	Knudsen, Alan 340B Manager Medical University Hospital Authority 8437925691	3/3/2021 8:03 AM
Addresses	Shipping Address	Insert	Change Request		MUSC Health West Infusion Center Pharmacy 2060 Sam Rittenburg Blvd Unit# E708 RM# SK2061 Charleston, SC 29407	10/13/2020 9:36 AM
Addresses	Shipping Address	Insert	Change Request		MUSC Health Chuck Dawley Medical Park 1106 Chuck Dawley Blvd Building A Mount Pleasant, SC 29464	10/13/2020 9:36 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 11:55 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		003162150A	9/11/2020 11:55 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/11/2020 11:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 11:55 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1073605879	9/11/2020 11:55 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/11/2020 11:55 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:55 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:55 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:55 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:55 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:55 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:55 AM
Details	Last Recertification Date	Update	Recertification	9/2/2019 7:24:29 PM	9/11/2020 11:55:08 AM	9/11/2020 11:55 AM
Addresses	Shipping Address	Insert	Change Request		Safecor 4060 Business Park Dr. Columbus, OH 43204	2/27/2020 7:46 AM
Addresses	Shipping Address	Insert	Change Request		MUSC Children's Hospital Pharmacy 10 McClennan Banks Dr. Charleston, SC 29425	9/15/2019 1:43 PM
Details	Last Recertification Date	Update	Recertification	9/5/2018 10:10:36 PM	9/2/2019 7:24:29 PM	9/2/2019 7:24 PM
Contacts	Authorizing Official	Update	Change Request	Wain, Matthew J COO MUSC 8437928533	Crawford, Thomas C Chief Operating Officer Medical University Hospital Authority 8437928775	8/20/2019 8:09 AM
Contacts	Primary Contact	Update	Change Request	Easterling, Heather Director, Pharmacy Services Medical University Hospital Authority 8437925691	Mills, Jason Pharmacy Manager Medical University Hospital Authority 8437927354	7/10/2019 6:00 AM
Addresses	Shipping Address	Insert	Change Request		MUSC CHILDRENS HLTH MED PAV PHARM 2250 MALL DR CHARLESTON, SC 29406	3/29/2019 1:45 PM
Addresses	Shipping Address	Insert	Change Request		MUSC CHILDRENS HLTH MED PAVIL INFUS 2250 MALL DR NORTH CHARLESTON, SC 29425	3/29/2019 1:45 PM
Details	Last Recertification Date	Update	Recertification	11/30/2017 10:36:19 AM	9/5/2018 10:10:36 PM	9/5/2018 10:10 PM
Addresses	Shipping Address	Insert	Change Request		MUSC-Pharmacy Compounding Center 650 Ellis Oak Dr Charleston, SC 29412	3/16/2018 2:08 PM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	11/30/2017 10:36:19 AM	11/30/2017 10:36 AM
Contacts	Primary Contact	Update	Recertification	Easterling, Heather Director, Pharmacy Services 8437925691	Easterling, Heather Director, Pharmacy Services Medical University Hospital Authority 8437925691	11/30/2017 10:12 AM
Contacts	Authorizing Official	Update	Profile Change Request	Wain, Matt j COO MUSC 8437928533	Wain, Matthew J COO MUSC 8437928533	11/30/2017 10:10 AM
Contacts	Authorizing Official	Update		Wain, Matt COO 8437928533	Wain, Matt j COO MUSC 8437928533	11/30/2017 10:03 AM
Contacts	Authorizing Official	Insert			Wain, Matt COO 8437928533	7/17/2017 7:28 AM
Contacts	Primary Contact	Insert			Easterling, Heather Director, Pharmacy Services 8437925691	2/27/2017 2:41 PM
Addresses	Main Address	Insert			169 ASHLEY AVENUE CHARLESTON, SC 29425	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC - NORTH CHARLESTON PHARMACY 2575 Elms Center Road Suite 100 NORTH CHARLESTON, SC 29406	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC- Mail Order Pharmacy 230 Albemarle Rd WH 126 Charleston, SC 29407	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC GIVEN-IN-CLINIC 135 Rutledge Avenue Charleston, SC 29425	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC Rutledge Towers Ambulatory OR 135 Rutledge Avenue, 120H Charleston, SC 29425	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC Rutledge Towers Outpatient 135 Rutledge Avenue, Room 106 Charleston, SC 29425	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC Ashley River Tower Phmy 25 Courtenay Drive, Room M-104 Charleston, SC 29425	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC Hollings Cancer Infusion Ctr Pharmacy 86 Jonathan Lucas Street Charleston, SC 29425	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC Holllings Cancer Ctr Pharmacy 86 Jonathan Lucas St, Room 114 Charleston, SC 29425	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC University Hospital Pharmacy 169 Ashley Avenue, Room 149 Charleston, SC 29425	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC Ashley River Twr Phmy 25 Courtenay Drive, Room 2007 Charleston, SC 29425	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			MUSC Institute of Psychiatry Pharmacy 67 President Street room PH448 Charleston, SC 29425	2/27/2017 2:40 PM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 12:07 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/17/2015 12:46 PM
Details	Last Recertification Date	Update		8/19/2014 12:00:00 AM	8/17/2015 12:00:00 AM	8/17/2015 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: Number	Insert			744042	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: State	Insert			SC	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: Number	Insert			797103	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: State	Insert			SC	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: Number	Insert			731027	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: State	Insert			SC	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: Number	Insert			713497	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: State	Insert			SC	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: Number	Insert			797506	2/10/2015 11:56 AM
Medicaid Billing	Medicaid: State	Insert			SC	2/10/2015 11:56 AM
Medicaid Billing	NPI: Number	Insert			1659435840	2/10/2015 11:56 AM
Medicaid Billing	NPI: Number	Insert			1659470433	2/10/2015 11:56 AM
Medicaid Billing	NPI: Number	Insert			1730329467	2/10/2015 11:56 AM
Medicaid Billing	NPI: Number	Insert			1659511061	2/10/2015 11:56 AM
Medicaid Billing	NPI: Number	Insert			1497039390	2/10/2015 11:56 AM
Medicaid Billing	NPI: Number	Insert			1821238551	2/10/2015 11:56 AM
Details	Last Recertification Date	Update		9/11/2013 12:00:00 AM	8/19/2014 12:00:00 AM	8/19/2014 11:49 AM
Medicaid Billing	Medicaid: Number	Update		744042	160808	11/1/2013 10:20 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/11/2013 12:00:00 AM	9/11/2013 2:03 PM
Details	Entity Name	Update		MEDICAL UNIVERSITY OF SOUTH CAROLINA	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	3/7/2013 12:12 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/7/2012 8:54 AM
Details	Comments Public	Insert			11/22/11, added ship to addr.(at 230 albemarle) 1/21/09 UPDATED ADDR (WAS 171 ASHLEY AVE.) 2/24/04 UPDATED MEDICAID # (WAS 702798, 708630)	11/22/2011 12:18 PM
Details	Last Recertification Date	Insert				12/2/2010 4:43 PM
Details	Grant Number	Insert				12/2/2010 4:43 PM
Details	340B ID	Insert			DSH420004	12/2/2010 4:43 PM
Details	Is Authorizing Official EHB Data	Insert				12/2/2010 4:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert				12/2/2010 4:43 PM
Details	Medicare Provider Number	Insert			420004	12/2/2010 4:43 PM
Details	Entity Name	Insert			MEDICAL UNIVERSITY OF SOUTH CAROLINA	12/2/2010 4:43 PM
Details	Program Code	Insert			DSH	12/2/2010 4:43 PM
Details	Entity Subname	Insert			MEDICAL UNIVERSITY HOSPITAL	12/2/2010 4:43 PM
Dates	Participating Approval Date	Insert			9/4/2007 12:00:00 AM	12/2/2010 4:43 PM
Details	State	Insert			Active	12/2/2010 4:43 PM
Dates	Registration Date	Insert			9/4/2007 12:00:00 AM	12/2/2010 4:43 PM
Dates	Signed By Date	Insert				12/2/2010 4:43 PM
Dates	Start Date	Insert			12/1/1992 12:00:00 AM	12/2/2010 4:43 PM
Terminations	Termination Comments	Insert				12/2/2010 4:43 PM
Terminations	Termination Date	Insert				12/2/2010 4:43 PM
Terminations	Termination Effective Date	Insert				12/2/2010 4:43 PM
Terminations	Termination Reason	Insert				12/2/2010 4:43 PM
Details	Comments Public	Insert			1/21/09 UPDATED ADDR (WAS 171 ASHLEY AVE.) 2/24/04 UPDATED MEDICAID # (WAS 702798, 708630)	12/2/2010 4:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	9/4/2007 7:01 AM
Medicaid Billing	Medicaid: Number	Insert			744042	9/4/2007 7:01 AM
Medicaid Billing	Medicaid: State	Insert			SC	9/4/2007 7:01 AM