Covered Entity Details

DSH420018M PALMETTO RICHLAND (Terminated) - information as of 5/15/2025 2:01:24 AM

Main Details

Name

PALMETTO RICHLAND

Subdivision Name

Palmetto Health Richland Springs

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH420018M

Medicare Provider Number

420018

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/11/2012

Participating Start Date

1/1/2013

Participating Approval Date

12/17/2012

Last Recertification Date

8/24/2015

Termination Date
Termination Reason

4/20/2016
Other

Contacts

Authorizing Official

Prisma Health Richland Hospital
Paul Johnson, Interim Chief Executive Officer
(803) 434-4500

Primary Contact

Palmetto Health
Dave Amsden, Director of Pharmacy Services
(803) 434-2535

Addresses

Street Address

11 Medical Park Drive
Columbia, SC 29203

Billing Address

Palmetto Health Pharmacy 10MP
10 Medical Park Drive
Columbia, SC 29203

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
12/17/12 David Lee has the authority to act on behalf of the hospital and enter the hospital into a legal agreement with the Federal Government.	12/17/2012

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	232488
		1487868097

Shipping Addresses

Shipping Address 1

Palmetto Health Pharmacy 10MP
10 Medical Park Drive
Columbia, SC 29203

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
DSH420018C	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	Children's Hospital Outpatient Center	9 Medical Park Drive	Columbia	SC	Active
DSH420018D	Child	DSH	Palmetto Richland	Palmetto Health Ortho Center	1801 Sunset Drive	Columbia	SC	Terminated
DSH420018E	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	Palmetto Health Women's Center	1801 Sunset Drive	Columbia	SC	Active
DSH420018F	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	PH Internal Medicine Center	1801 Sunset Drive	Columbia	SC	Active
DSH420018G	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	Prisma Health Infusion Center	3010 Farrow Road	Columbia	SC	Active
DSH420018H	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	Senior Primary Care	3010 Farrow Road	Columbia	SC	Active
DSH420018J	Child	DSH	Palmetto Richland	Senior Primary Care - Parkridge	100 Palmetto Health Parkway	Columbia	SC	Terminated
DSH420018K	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	Family Practice	3209 Colonial Drive	Columbia	SC	Active
DSH420018M	Child	DSH	PALMETTO RICHLAND	Palmetto Health Richland Springs	11 Medical Park Drive	Columbia	SC	Terminated
DSH420018N	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	PSC Lexington County	700 Knox Abbott Drive	West Columbia	SC	Terminated
DSH420018P	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	PSC Laurel	PSC Laurel	Columbia	SC	Terminated
DSH420018Q	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	PSC Shandon	PSC Shandon	Columbia	SC	Terminated
DSH420018R	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	PSC White Rock	PSC White Rock	White Rock	SC	Terminated
DSH420018T	Child	DSH	Palmetto Richland	Celia Saxon Health Center	2133 Walker Solomon Way	Columbia	SC	Terminated
DSH420018U	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	Prisma Health Cancer Institute - Columbia	14 Richland Medical Park	Columbia	SC	Active
DSH420018V	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	Prisma Health Pediatric Pulmonology - Pulmonology	9 Richland Medical Park Drive	Columbia	SC	Active
DSH420018W	Child	DSH	PRISMA HEALTH RICHLAND HOSPITAL	Pediatric Hematology and Oncology - Hematology and Oncology	7 Richland Medical Park Drive	Columbia	SC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Hamm, Jay D Chief Executive Officer Prisma Health Richland Hospital 8034344688	Johnson, Paul Interim Chief Executive Officer Prisma Health Richland Hospital 8034344500	1/15/2020 1:04 PM
Contacts	Authorizing Official	Update	Change Request	Hamm, Jay Chief Operating Officer Palmetto Health Richland 8034344688	Hamm, Jay D Chief Executive Officer Prisma Health Richland Hospital 8034344688	10/25/2019 1:23 PM
Contacts	Authorizing Official	Update	Change Request	Cunningham, Benjamin Martin System VP - Finance Palmetto Health 8032962448	Hamm, Jay Chief Operating Officer Palmetto Health Richland 8034344688	2/1/2018 8:37 AM
Contacts	Authorizing Official	Insert	Change Request		Cunningham, Benjamin Martin System VP - Finance Palmetto Health 8032962448	10/2/2017 7:25 AM
Contacts	Primary Contact	Update		Amsden, Dave Director of Pharmacy Services 8034342535	Amsden, Dave Director of Pharmacy Services Palmetto Health 8034342535	9/26/2017 10:27 AM
Contacts	Primary Contact	Insert			Amsden, Dave Director of Pharmacy Services 8034342535	4/20/2017 7:01 PM
Contacts	Signed By	Insert			Lee, David F. Director of Financial Forecasting 8032963632	4/20/2017 7:01 PM
Dates	Last Date That 340B Drugs Purchased	Update			6/30/2015 12:00:00 AM	4/20/2016 8:43 AM
Details	State	Update		Active	Terminated	4/20/2016 8:43 AM
Terminations	Termination Comments	Update			Audit finding: Since PH Richland Springs’s outpatient services relocated and provided inpatient services only and showed no reimbursable outpatient costs or charges on PR’s most recently filed Medicare cost report, the facility was not eligible to be registered on the 340B Database. Does not need to be included on termination list, PPQ will handle the notification.	4/20/2016 8:43 AM
Terminations	Termination Date	Update			4/20/2016 12:00:00 AM	4/20/2016 8:43 AM
Terminations	Termination Effective Date	Update			3/2/2015 12:00:00 AM	4/20/2016 8:43 AM
Terminations	Termination Reason	Update			Other	4/20/2016 8:43 AM
Addresses	Main Address	Insert			11 Medical Park Drive Columbia, SC 29203	4/20/2016 8:43 AM
Addresses	Billing Address	Insert			Palmetto Health Pharmacy 10MP 10 Medical Park Drive Columbia, SC 29203	4/20/2016 8:43 AM
Addresses	Shipping Address	Insert			Palmetto Health Pharmacy 10MP 10 Medical Park Drive Columbia, SC 29203	4/20/2016 8:43 AM
Details	Last Recertification Date	Update		8/15/2014 12:00:00 AM	8/24/2015 12:00:00 AM	8/24/2015 2:35 PM
Details	Last Recertification Date	Update		8/22/2013 6:10:13 PM	8/15/2014 12:00:00 AM	8/15/2014 12:47 PM
Details	Last Recertification Date	Update			8/22/2013 6:10:13 PM	8/22/2013 6:10 PM
Details	340B ID	Update		IS-DR-DSH420018M	DSH420018M	12/17/2012 12:58 PM
Details	Entity Name	Update		PALMETTO RICHLAND MEMORIAL HOSPITAL	PALMETTO RICHLAND	12/17/2012 12:58 PM
Dates	Participating Approval Date	Update			12/17/2012 12:00:00 AM	12/17/2012 12:58 PM
Details	State	Update		Pending	Active	12/17/2012 12:58 PM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	12/17/2012 12:58 PM
Details	Comments Public	Insert			12/17/12 David Lee has the authority to act on behalf of the hospital and enter the hospital into a legal agreement with the Federal Government.	12/17/2012 12:58 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-DR-DSH420018M	12/14/2012 8:14 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/11/2012 5:42 PM
Medicaid Billing	Medicaid: Number	Insert			232488	10/11/2012 5:42 PM
Medicaid Billing	Medicaid: State	Insert			SC	10/11/2012 5:42 PM
Medicaid Billing	NPI: Number	Insert			1487868097	10/11/2012 5:42 PM
Details	Last Recertification Date	Insert				10/11/2012 5:42 PM
Details	Grant Number	Insert				10/11/2012 5:42 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/11/2012 5:42 PM
Details	Is Authorizing Official EHB Data	Insert				10/11/2012 5:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/11/2012 5:42 PM
Details	Medicare Provider Number	Insert			420018	10/11/2012 5:42 PM
Details	Entity Name	Insert			PALMETTO RICHLAND MEMORIAL HOSPITAL	10/11/2012 5:42 PM
Details	Program Code	Insert			DSH	10/11/2012 5:42 PM
Details	Entity Subname	Insert			Palmetto Health Richland Springs	10/11/2012 5:42 PM
Dates	Participating Approval Date	Insert				10/11/2012 5:42 PM
Details	State	Insert			Pending	10/11/2012 5:42 PM
Dates	Registration Date	Insert			10/11/2012 12:00:00 AM	10/11/2012 5:42 PM
Dates	Signed By Date	Insert			10/11/2012 12:00:00 AM	10/11/2012 5:42 PM
Dates	Start Date	Insert				10/11/2012 5:42 PM
Terminations	Termination Comments	Insert				10/11/2012 5:42 PM
Terminations	Termination Date	Insert				10/11/2012 5:42 PM
Terminations	Termination Effective Date	Insert				10/11/2012 5:42 PM
Terminations	Termination Reason	Insert				10/11/2012 5:42 PM