Covered Entity Details

DSH420004AT MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Active) - information as of 4/25/2025 6:35:47 PM

Main Details

Name

MEDICAL UNIVERSITY HOSPITAL AUTHORITY

Subdivision Name

Rutledge Tower Pain Management

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH420004AT

Medicare Provider Number

420004

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/26/2012

Participating Start Date

10/1/2012

Participating Approval Date

8/30/2012

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

135 Rutledge 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
No records to display.

Medicaid Billing

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

State	Medicaid Number	NPI Number
SC	160808,744042,797103,731027,713497,797506	1659435840,1659470433,1730329467,1659511061,1497039390,1821238551
GA	003162150A
NC	1073605879

Shipping Addresses

Shipping Address 1

Medical University of South Carolina
169 Ashley Avenue
Charleston, SC 29425

Contract Pharmacies

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

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
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
Details	Last Recertification Date	Update	Recertification	8/16/2023 10:11:35 AM	8/19/2024 12:56:05 PM	8/19/2024 12:56 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
Addresses	Billing Address	Insert	Group Change Request		MEDICAL UNIVERSITY HOSPITAL AUTHORITY PO Box 31244 Salt Lake City, UT 84131	3/25/2024 1:16 PM
Details	Last Recertification Date	Update	Recertification	8/26/2022 2:22:16 PM	8/16/2023 10:11:35 AM	8/16/2023 10:11 AM
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
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
Details	Last Recertification Date	Update	Recertification	8/20/2021 1:23:09 PM	8/26/2022 2:22:16 PM	8/26/2022 2:22 PM
Contacts	Primary Contact	Update	Group Change Request	Crowley, Kelly Director MUSC 8437921009	Kushner, Gail Marcia Director, 340B MEDICAL UNIVERSITY HOSPITAL AUTHORITY 2038584254	7/11/2022 1:16 PM
Contacts	Primary Contact	Update	Change Request	Knudsen, Alan 340B Manager Medical University Hospital Authority 8437925691	Crowley, Kelly Director MUSC 8437921009	12/13/2021 1:19 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 11:56:54 AM	8/20/2021 1:23:09 PM	8/20/2021 1:23 PM
Contacts	Primary Contact	Update	Change Request	Easterling, Heather Director, Pharmacy Services Medical University Hospital Authority 8437925691	Knudsen, Alan 340B Manager Medical University Hospital Authority 8437925691	4/7/2021 7:38 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		003162150A	9/11/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/11/2020 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1073605879	9/11/2020 11:56 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	9/11/2020 11:56 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:56 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:56 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:56 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:56 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:56 AM
Medicaid Billing	NPI: State	Update	Recertification		SC	9/11/2020 11:56 AM
Details	Last Recertification Date	Update	Recertification	8/26/2019 5:42:47 PM	9/11/2020 11:56:54 AM	9/11/2020 11:56 AM
Details	Last Recertification Date	Update	Recertification	9/5/2018 10:26:53 PM	8/26/2019 5:42:47 PM	8/26/2019 5:42 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
Details	Last Recertification Date	Update	Recertification	11/30/2017 10:28:38 AM	9/5/2018 10:26:53 PM	9/5/2018 10:26 PM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	11/30/2017 10:28:38 AM	11/30/2017 10:28 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	Update		Kokko, Heather Director, Pharmacy Services 8437925691	Easterling, Heather Director, Pharmacy Services 8437925691	2/27/2017 2:41 PM
Contacts	Signed By	Insert			Smith, Stuart W. CEO 8437924000	2/27/2017 2:41 PM
Addresses	Main Address	Insert			135 Rutledge Avenue Charleston, SC 29425	2/27/2017 2:40 PM
Addresses	Shipping Address	Insert			Medical University of South Carolina 169 Ashley Avenue 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 12:08 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 1:36 PM
Medicaid Billing	Medicaid: Number	Insert			744042	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: State	Insert			SC	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: Number	Insert			797103	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: State	Insert			SC	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: Number	Insert			731027	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: State	Insert			SC	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: Number	Insert			713497	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: State	Insert			SC	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: Number	Insert			797506	2/10/2015 1:36 PM
Medicaid Billing	Medicaid: State	Insert			SC	2/10/2015 1:36 PM
Medicaid Billing	NPI: Number	Insert			1659435840	2/10/2015 1:36 PM
Medicaid Billing	NPI: Number	Insert			1659470433	2/10/2015 1:36 PM
Medicaid Billing	NPI: Number	Insert			1730329467	2/10/2015 1:36 PM
Medicaid Billing	NPI: Number	Insert			1659511061	2/10/2015 1:36 PM
Medicaid Billing	NPI: Number	Insert			1497039390	2/10/2015 1:36 PM
Medicaid Billing	NPI: Number	Insert			1821238551	2/10/2015 1:36 PM
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
Details	Last Recertification Date	Update		9/11/2013 2:03:27 PM	9/11/2013 12:00:00 AM	3/7/2014 6:45 PM
Contacts	Primary Contact	Insert			Kokko, Heather Director, Pharmacy Services 8437925691	9/11/2013 2:03 PM
Details	Last Recertification Date	Update			9/11/2013 2:03:27 PM	9/11/2013 2:03 PM
Details	Entity Name	Update		Medical University Hospital Authority	MEDICAL UNIVERSITY HOSPITAL AUTHORITY	3/7/2013 4:09 PM
Details	Entity Name	Update		MEDICAL UNIVERSITY OF SOUTH CAROLINA	Medical University Hospital Authority	3/7/2013 4:00 PM
Details	340B ID	Update		IS-DR-DSH420004AT	DSH420004AT	8/30/2012 5:42 PM
Dates	Participating Approval Date	Update			8/30/2012 12:00:00 AM	8/30/2012 5:42 PM
Details	State	Update		Pending	Active	8/30/2012 5:42 PM
Dates	Start Date	Update			10/1/2012 12:00:00 AM	8/30/2012 5:42 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-DR-DSH420004AT	8/27/2012 10:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/26/2012 5:38 PM
Medicaid Billing	Medicaid: Number	Insert			160808	7/26/2012 5:38 PM
Medicaid Billing	Medicaid: State	Insert			SC	7/26/2012 5:38 PM
Details	Last Recertification Date	Insert				7/26/2012 5:38 PM
Details	Grant Number	Insert				7/26/2012 5:38 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	7/26/2012 5:38 PM
Details	Is Authorizing Official EHB Data	Insert				7/26/2012 5:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/26/2012 5:38 PM
Details	Medicare Provider Number	Insert			420004	7/26/2012 5:38 PM
Details	Entity Name	Insert			MEDICAL UNIVERSITY OF SOUTH CAROLINA	7/26/2012 5:38 PM
Details	Program Code	Insert			DSH	7/26/2012 5:38 PM
Details	Entity Subname	Insert			Rutledge Tower Pain Management	7/26/2012 5:38 PM
Dates	Participating Approval Date	Insert				7/26/2012 5:38 PM
Details	State	Insert			Pending	7/26/2012 5:38 PM
Dates	Registration Date	Insert			7/26/2012 12:00:00 AM	7/26/2012 5:38 PM
Dates	Signed By Date	Insert			7/26/2012 12:00:00 AM	7/26/2012 5:38 PM
Dates	Start Date	Insert				7/26/2012 5:38 PM
Terminations	Termination Comments	Insert				7/26/2012 5:38 PM
Terminations	Termination Date	Insert				7/26/2012 5:38 PM
Terminations	Termination Effective Date	Insert				7/26/2012 5:38 PM
Terminations	Termination Reason	Insert				7/26/2012 5:38 PM