Covered Entity Details

STD292032 University of South Carolina School of Medicine Educational Trust (Terminated) - information as of 6/6/2025 12:41:49 PM

Main Details

Name

University of South Carolina School of Medicine Educational Trust

Subdivision Name

Department of Internal Medicine

Type

Sexually Transmitted Diseases

340B ID

STD292032

Grant Number

1NH25PS005150-01-00

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

Direct Funding (dollars received from CDC or an intermediate organization)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.

Additional Details

Current Program Status

Terminated

Registration Date

10/13/2017

Participating Start Date

1/1/2018

Participating Approval Date

11/21/2017

Last Recertification Date

5/22/2019

Notice of Funding Opportunity (NOFO) Number

Termination Date
Termination Reason

10/1/2019
Business decision by the Covered Entity

Contacts

Authorizing Official

Department of Public Health
Bernard Gilliard, Program Manager - DIS and Partner Services
(803) 898-0452

Primary Contact

PH Immunology Center
Rajashree C. Rao, Practice Operations Manager, Infectious Diseases Division
(803) 434-2714

Addresses

Street Address

1 Richland Medical Park, Suite 420
Columbia, SC 29203

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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?
No

Shipping Addresses

Shipping Address 1

USC Immunology Center
1 Richland Medical Park, Suite 420
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
Contract Detail	LONG'S KILBOURNE ROAD PHARMACY	D/B/A AVITA PHARMACY 1053	630 KILBOURNE RD	COLUMBIA	SC	29205-2827	07/16/2018	10/01/2018		10/01/2019	10/01/2019
Contract Detail	LONGS DRUGS OF LEXINGTON SC INC		1216 WEST MAIN ST	LEXINGTON	SC	29072	07/17/2018	10/01/2018		10/01/2019	10/01/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Gilliard, Bernard Program Manager - DIS and Partner Services Department of Health and Environmental Control 8038980452	Gilliard, Bernard Program Manager - DIS and Partner Services Department of Public Health 8038980452	3/18/2025 12:06 PM
Contacts	Signed By	Update	Profile Change Request	Gilliard, Bernard Program Manager - DIS and Partner Services Department of Health and Environmental Control 8038980452	Gilliard, Bernard Program Manager - DIS and Partner Services Department of Public Health 8038980452	3/18/2025 12:06 PM
Contacts	Primary Contact	Update	Profile Change Request	Rao, Rajashree C. Practice Operations Manager, Infectious Diseases Division USC Immunology Center 8034342714	Rao, Rajashree C. Practice Operations Manager, Infectious Diseases Division PH Immunology Center 8034342714	1/19/2022 12:22 PM
Contacts	Primary Contact	Update	Profile Change Request	Rao, Rajashree C. Director of Infectious Diseases Division USC Immunology Center 8035455358	Rao, Rajashree C. Practice Operations Manager, Infectious Diseases Division USC Immunology Center 8034342714	1/18/2022 9:00 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		6/30/2019 12:00:00 AM	7/1/2019 8:57 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/1/2019 8:57 AM
Terminations	Termination Comments	Update	Termination Request		Site merged with another entity and this account is getting inactivated.	7/1/2019 8:57 AM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	7/1/2019 8:57 AM
Terminations	Termination Effective Date	Update	Termination Request		7/1/2019 12:00:00 AM	7/1/2019 8:57 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	7/1/2019 8:57 AM
Details	Last Recertification Date	Update	Recertification	4/27/2018 8:53:40 AM	5/22/2019 9:31:22 AM	5/22/2019 9:31 AM
Details	Grant Number	Update	Recertification	5NH25PS004378-04-00	1NH25PS005150-01-00	5/22/2019 9:31 AM
Details	Last Recertification Date	Update	Recertification		4/27/2018 8:53:40 AM	4/27/2018 8:53 AM
Details	State	Update		Approved	Active	1/1/2018 12:00 AM
Addresses	Main Address	Insert	New Registration		1 Richland Medical Park, Suite 420 Columbia, SC 29203	11/21/2017 10:20 AM
Contacts	Signed By	Insert	New Registration		Gilliard, Bernard Program Manager - DIS and Partner Services Department of Health and Environmental Control 8038980452	11/21/2017 10:20 AM
Details	Grant Number	Update	New Registration	HV-7-558	5NH25PS004378-04-00	11/21/2017 10:20 AM
Details	340B ID	Update	New Registration		STD292032	11/21/2017 10:20 AM
Dates	Participating Approval Date	Update	New Registration		11/21/2017 10:20:22 AM	11/21/2017 10:20 AM
Details	State	Update	New Registration	Pending	Approved	11/21/2017 10:20 AM
Dates	Signed By Date	Update	New Registration		11/3/2017 11:25:01 AM	11/21/2017 10:20 AM
Dates	Start Date	Update	New Registration		1/1/2018 12:00:00 AM	11/21/2017 10:20 AM
Addresses	Shipping Address	Delete	New Registration	Longs Kilbourne Road Pharmacy 630 Kilbourne Road Columbia, SC 29205		10/13/2017 10:43 AM
Addresses	Shipping Address	Delete	New Registration	Longs Drugs of Lexington SC Inc 1216 West Main Street Lexington, SC 29072		10/13/2017 10:43 AM
Addresses	Main Address	Insert	New Registration		1 Richland Medical Park, Suite 420 Columbia, SC 29203	10/13/2017 10:43 AM
Addresses	Shipping Address	Insert	New Registration		Longs Kilbourne Road Pharmacy 630 Kilbourne Road Columbia, SC 29205	10/13/2017 10:43 AM
Addresses	Shipping Address	Insert	New Registration		USC Immunology Center 1 Richland Medical Park, Suite 420 Columbia, SC 29203	10/13/2017 10:43 AM
Addresses	Shipping Address	Insert	New Registration		Longs Drugs of Lexington SC Inc 1216 West Main Street Lexington, SC 29072	10/13/2017 10:43 AM
Details	Nature Of Support	Insert	New Registration		Direct Funding (dollars received from CDC or an intermediate organization)	10/13/2017 10:43 AM
Contacts	Primary Contact	Insert	New Registration		Rao, Rajashree C. Director of Infectious Diseases Division USC Immunology Center 8035455358	10/13/2017 10:43 AM
Contacts	Authorizing Official	Insert	New Registration		Gilliard, Bernard Program Manager - DIS and Partner Services Department of Health and Environmental Control 8038980452	10/13/2017 10:43 AM
Details	Last Recertification Date	Insert	New Registration			10/13/2017 10:43 AM
Details	Grant Number	Insert	New Registration		HV-7-558	10/13/2017 10:43 AM
Details	340B ID	Insert	New Registration			10/13/2017 10:43 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/13/2017 10:43 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/13/2017 10:43 AM
Details	Medicare Provider Number	Insert	New Registration			10/13/2017 10:43 AM
Details	Entity Name	Insert	New Registration		University of South Carolina School of Medicine Educational Trust	10/13/2017 10:43 AM
Details	Program Code	Insert	New Registration		STD	10/13/2017 10:43 AM
Details	Entity Subname	Insert	New Registration		Department of Internal Medicine	10/13/2017 10:43 AM
Dates	Participating Approval Date	Insert	New Registration			10/13/2017 10:43 AM
Details	State	Insert	New Registration		Pending	10/13/2017 10:43 AM
Dates	Registration Date	Insert	New Registration		10/13/2017 10:43:27 AM	10/13/2017 10:43 AM
Dates	Signed By Date	Insert	New Registration			10/13/2017 10:43 AM
Dates	Start Date	Insert	New Registration			10/13/2017 10:43 AM
Terminations	Termination Comments	Insert	New Registration			10/13/2017 10:43 AM
Terminations	Termination Date	Insert	New Registration			10/13/2017 10:43 AM
Terminations	Termination Effective Date	Insert	New Registration			10/13/2017 10:43 AM
Terminations	Termination Reason	Insert	New Registration			10/13/2017 10:43 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History