Covered Entity Details

DSH420049C CONWAY HOSPITAL (Terminated) - information as of 5/17/2025 10:51:45 PM

Main Details

Name

CONWAY HOSPITAL

Subdivision Name

CMC PRIMARY CARE-BELL STREET - CMC- Primary Care Bell Street

Type

Disproportionate Share Hospital

Rural

340B ID

DSH420049C

Medicare Provider Number

420049

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/10/2020

Participating Start Date

4/1/2020

Participating Approval Date

3/10/2020

Last Recertification Date

8/18/2023

Termination Date
Termination Reason

10/1/2023
Site closure

Contacts

Authorizing Official

Conway Hospital
Angela Williford, Chief Administrative Officer
(843) 347-8166

Primary Contact

Conway Hospital Inc dba Conway Medical Center
Andrew Wright, Director of Pharmacy
(843) 347-8142

Addresses

Street Address

903 BELL STREET
CONWAY, SC 29526

Billing Address
Same as Street Address

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	GP4505	1780995373

Shipping Addresses

Same as Street Address

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
DSH420049A	Child	DSH	CONWAY HOSPITAL	CMC Pediatrics - Socastee	6010 Highway 707	Myrtle Beach	SC	Active
DSH420049AA	Child	DSH	CONWAY HOSPITAL	CMC Godwin Healing Center	394 Singleton Ridge Road	Conway	SC	Active
DSH420049AB	Child	DSH	CONWAY HOSPITAL	CMC Rheumatolgy	300 Singleton Ridge Road	Conway	SC	Active
DSH420049AC	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Market Common	1600 Farrow Parkway	Myrtle Beach	SC	Active
DSH420049AD	Child	DSH	CONWAY HOSPITAL	CMC Infectious Diseases	2361 Cypress Circle	Conway	SC	Active
DSH420049AE	Child	DSH	CONWAY HOSPITAL	CMC Dermatology	808 Farrar Drive	Conway	SC	Active
DSH420049AF	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Little River	4237 River Hills Drive	Little River	SC	Active
DSH420049AG	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Bellamy Avenue	631 Bellamy Avenue	Murrells Inlet	SC	Active
DSH420049AH	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Prince Creek	11899 Highway 707	Murrells Inlet	SC	Active
DSH420049AJ	Child	DSH	CONWAY HOSPITAL	CMC Imaging Center Church Street - Diagnostic/Imaging	2701 Church Street	Conway	SC	Active
DSH420049AK	Child	DSH	CONWAY HOSPITAL	CMC Surgical Center South - Ambulatory Surgery Center	6010 Highway 707	Myrtle Beach	SC	Active
DSH420049AL	Child	DSH	CONWAY HOSPITAL	CMC Women's Health - Socastee - OB/GYN	6010 Highway 707	Myrtle Beach	SC	Active
DSH420049AM	Child	DSH	CONWAY HOSPITAL	CMC Weight Loss - Bariatrics	2361 Cypress Circle	Conway	SC	Active
DSH420049AN	Child	DSH	CONWAY HOSPITAL	CMC Surgical Associates Socastee - Surgery Office	6010 Highway 707	Myrtle Beach	SC	Active
DSH420049AP	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Grande Dunes	1100 62nd Ave N	Myrtle Beach	SC	Active
DSH420049AQ	Child	DSH	CONWAY HOSPITAL	CMC Primary Care Church Street - Primary Care	2701 Church St	Conway	SC	Active
DSH420049AR	Child	DSH	CONWAY HOSPITAL	CMC Infusion Center University Commons - Infusion Services	201 Graduate Rd	Conway	SC	Active
DSH420049AS	Child	DSH	CONWAY HOSPITAL	CMC Ear, Nose, and Throat - Socastee	6010 Highway 707	Myrtle Beach	SC	Active
DSH420049AT	Child	DSH	CONWAY HOSPITAL	CMC Dermatology - Grande Dunes	1100 62nd Ave N	Myrtle Beach	SC	Active
DSH420049AU	Child	DSH	CONWAY HOSPITAL	CMC Student Health at CCU	251 University Blvd	Conway	SC	Active
DSH420049AV	Child	DSH	CONWAY HOSPITAL	CMC Cancer Center Infusion - Cancer Infusion	394 Singleton Ridge Rd	Conway	SC	Active
DSH420049AW	Child	DSH	CONWAY HOSPITAL	CMC Orthopedics - Socastee	6010 Highway 707	Myrtle Beach	SC	Active
DSH420049AX	Child	DSH	CONWAY HOSPITAL	CMC Wound Care - Hyperbaric	300 Singleton Ridge Rd	Conway	SC	Terminated
DSH420049B	Child	DSH	CONWAY HOSPITAL	CMC Digestive Health	2376 Cypress Circle	Conway	SC	Active
DSH420049C	Child	DSH	CONWAY HOSPITAL	CMC PRIMARY CARE-BELL STREET - CMC- Primary Care Bell Street	903 BELL STREET	CONWAY	SC	Terminated
DSH420049D	Child	DSH	CONWAY HOSPITAL	CMC Surgical Associates	2361 Cypress Circle	Conway	SC	Active
DSH420049E	Child	DSH	CONWAY HOSPITAL	CMC Pediatrics - Conway	124 Professional Park Drive	Conway	SC	Active
DSH420049F	Child	DSH	CONWAY HOSPITAL	CMC Ear, Nose and Throat	620 Singleton Ridge Road	CONWAY	SC	Active
DSH420049G	Child	DSH	CONWAY HOSPITAL	CMC Imaging Center	801 Farrar Drive	Conway	SC	Active
DSH420049H	Child	DSH	CONWAY HOSPITAL	CMC Cardiology	2376 Cypress Circle	Conway	SC	Active
DSH420049J	Child	DSH	CONWAY HOSPITAL	CMC Endocrinology	847 Farrar Drive	Conway	SC	Active
DSH420049K	Child	DSH	CONWAY HOSPITAL	CMC Neurology	8024 Myrtle Trace Drive	Conway	SC	Active
DSH420049L	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Conway	2367-B Cypress Circle	Conway	SC	Active
DSH420049M	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Creel Street	1301 Creel Street	Conway	SC	Active
DSH420049N	Child	DSH	CONWAY HOSPITAL	CMC WOMEN'S HEALTH-TOWNE CENTER - CMC Women's Helath at Towne Centre	5010 CAROLINA FOREST BLVD	MYRTLE BEACH	SC	Terminated
DSH420049P	Child	DSH	CONWAY HOSPITAL	CMC Pediatrics - Carolina Forest	4022 Postal Way	Myrtle Beach	SC	Active
DSH420049Q	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Socastee	6010 Highway 707	Myrtle Beach	SC	Active
DSH420049R	Child	DSH	CONWAY HOSPITAL	CMC Pulmonary and Sleep Medicine	2376 Cypress Circle	Conway	SC	Active
DSH420049S	Child	DSH	CONWAY HOSPITAL	CMC Women's Health - Conway	2376 Cypress Circle	Conway	SC	Active
DSH420049T	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Towne Center	5010 Carolina Forest Boulevard	Myrtle Beach	SC	Active
DSH420049U	Child	DSH	CONWAY HOSPITAL	CMC Pain Management	811 82nd Parkway	Myrtle Beach	SC	Active
DSH420049V	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Surfside Beach	1413 Highway 17 North	Surfside Beach	SC	Active
DSH420049W	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Postal Way	4022 Postal Way	Myrtle Beach	SC	Active
DSH420049X	Child	DSH	CONWAY HOSPITAL	CMC Orthopaedics	8004 Myrtle Trace Drive	Conway	SC	Active
DSH420049Y	Child	DSH	CONWAY HOSPITAL	CMC-Primary Care Myrtle Trace	8004 Myrtle Trace Drive	Conway	SC	Terminated
DSH420049Z	Child	DSH	CONWAY HOSPITAL	CMC Primary Care - Highway 90	4300 Highway 90	Conway	SC	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/5/2023 12:00:00 AM	9/14/2023 11:49 AM
Details	State	Update	Termination Request	Active	To Be Terminated	9/14/2023 11:49 AM
Terminations	Termination Comments	Update	Termination Request		Office closed on 9/11/2023	9/14/2023 11:49 AM
Terminations	Termination Date	Update	Termination Request		10/1/2023 12:00:00 AM	9/14/2023 11:49 AM
Terminations	Termination Effective Date	Update	Termination Request		9/11/2023 12:00:00 AM	9/14/2023 11:49 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	9/14/2023 11:49 AM
Details	Last Recertification Date	Update	Recertification	8/25/2022 8:44:05 AM	8/18/2023 10:33:55 AM	8/18/2023 10:33 AM
Contacts	Authorizing Official	Update	AO Change Request	Barr, Bret Alan CEO Conway Hospital, Inc. 8433478114	Williford, Angela Chief Administrative Officer Conway Hospital 8433478166	1/18/2023 4:35 PM
Details	Last Recertification Date	Update	Recertification	8/25/2021 1:44:46 PM	8/25/2022 8:44:05 AM	8/25/2022 8:44 AM
Contacts	Primary Contact	Update	Group Change Request	GAJEWSKI, ROBERT Andrew DIRECTOR OF PHARMACY Conway Hospital, Inc. 8433478120	Wright, Andrew Director of Pharmacy Conway Hospital Inc dba Conway Medical Center 8433478142	4/12/2022 4:21 PM
Details	Last Recertification Date	Update	Recertification	9/14/2020 8:50:13 AM	8/25/2021 1:44:46 PM	8/25/2021 1:44 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1749180 (SC)		9/14/2020 8:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 8:50 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		GP4505	9/14/2020 8:50 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/14/2020 8:50 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1134172000 ( )		9/14/2020 8:50 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1780995373	9/14/2020 8:50 AM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/14/2020 8:50 AM
Details	Last Recertification Date	Update	Recertification		9/14/2020 8:50:13 AM	9/14/2020 8:50 AM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		Barr, Bret Alan CEO Conway Hospital, Inc. 8433478114	3/10/2020 2:38 PM
Details	340B ID	Update	New Registration		DSH420049C	3/10/2020 2:38 PM
Details	Entity Subname	Update	New Registration	CMC PRIMARY CARE-BELL STREET	CMC PRIMARY CARE-BELL STREET - CMC- Primary Care Bell Street	3/10/2020 2:38 PM
Dates	Participating Approval Date	Update	New Registration		3/10/2020 2:38:09 PM	3/10/2020 2:38 PM
Details	State	Update	New Registration	Pending	Approved	3/10/2020 2:38 PM
Dates	Signed By Date	Update	New Registration		1/13/2020 10:33:25 AM	3/10/2020 2:38 PM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	3/10/2020 2:38 PM
Addresses	Main Address	Insert	New Registration		903 BELL STREET CONWAY, SC 29526	1/10/2020 11:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/10/2020 11:52 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1749180	1/10/2020 11:52 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		SC	1/10/2020 11:52 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1134172000	1/10/2020 11:52 AM
Contacts	Primary Contact	Insert	New Registration		GAJEWSKI, ROBERT Andrew DIRECTOR OF PHARMACY Conway Hospital, Inc. 8433478120	1/10/2020 11:52 AM
Contacts	Authorizing Official	Insert	New Registration		Barr, Bret Alan CEO Conway Hospital, Inc. 8433478114	1/10/2020 11:52 AM
Details	Last Recertification Date	Insert	New Registration			1/10/2020 11:52 AM
Details	Grant Number	Insert	New Registration			1/10/2020 11:52 AM
Details	340B ID	Insert	New Registration			1/10/2020 11:52 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/10/2020 11:52 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/10/2020 11:52 AM
Details	Medicare Provider Number	Insert	New Registration		420049	1/10/2020 11:52 AM
Details	Entity Name	Insert	New Registration		CONWAY HOSPITAL	1/10/2020 11:52 AM
Details	Program Code	Insert	New Registration		DSH	1/10/2020 11:52 AM
Details	Entity Subname	Insert	New Registration		CMC PRIMARY CARE-BELL STREET	1/10/2020 11:52 AM
Dates	Participating Approval Date	Insert	New Registration			1/10/2020 11:52 AM
Details	State	Insert	New Registration		Pending	1/10/2020 11:52 AM
Dates	Registration Date	Insert	New Registration		1/10/2020 11:52:17 AM	1/10/2020 11:52 AM
Dates	Signed By Date	Insert	New Registration			1/10/2020 11:52 AM
Dates	Start Date	Insert	New Registration			1/10/2020 11:52 AM
Terminations	Termination Comments	Insert	New Registration			1/10/2020 11:52 AM
Terminations	Termination Date	Insert	New Registration			1/10/2020 11:52 AM
Terminations	Termination Effective Date	Insert	New Registration			1/10/2020 11:52 AM
Terminations	Termination Reason	Insert	New Registration			1/10/2020 11:52 AM