Covered Entity Details

DSH420036B MUSC Health Lancaster Medical Center (Active) - information as of 6/12/2025 4:44:49 AM

Main Details

Name

MUSC Health Lancaster Medical Center

Subdivision Name

LAN - Physical Therapy Indian Land (LMC)(CC001531) - Physical Therapy

Type

Disproportionate Share Hospital

Rural

340B ID

DSH420036B

Medicare Provider Number

420036

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/13/2023

Participating Start Date

1/1/2024

Participating Approval Date

11/1/2023

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

2816 World Reach Dr
Fort Mill, SC 29707

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	254485,441901,7Z1196	1144793654,1528739810,1700359205,1255804753
GA	003162150A
NC		1073605879

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
DSH420036A	Child	DSH	MUSC Health Lancaster Medical Center	LAN - Occupational Therapy - IP & OP (LMC) (CC001519) - Occupational Therapy	1025 West Meeting St	LANCASTER	SC	Active
DSH420036B	Child	DSH	MUSC Health Lancaster Medical Center	LAN - Physical Therapy Indian Land (LMC)(CC001531) - Physical Therapy	2816 World Reach Dr	Fort Mill	SC	Active
DSH420036C	Child	DSH	MUSC Health Lancaster Medical Center	Mid Carolinas Transplant Center - Transplant Center	820 West Meeting St	Lancaster	SC	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
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	8/19/2024 12:09 PM
Details	Last Recertification Date	Update	Recertification		8/19/2024 11:22:09 AM	8/19/2024 11:22 AM
Addresses	Billing Address	Update	Group Change Request	MUSC HEALTH LANCASTER MEDICAL CENTER 800 WEST MEETING STREET LANCASTER, SC 29720	MEDICAL UNIVERSITY HOSPITAL AUTHORITY PO Box 31244 Salt Lake City, UT 84131	3/25/2024 1:15 PM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Contacts	Authorizing Official	Update	Change Request	Goodlett, Lisa Chief Financial Officer Medical University Hospital Authority 8437924775	Crawford, Thomas C Chief Operating Officer Medical University Hospital Authority 8437928775	11/27/2023 2:39 PM
Contacts	Signed By	Insert	New Registration		Goodlett, Lisa Chief Financial Officer Medical University Hospital Authority 8437924775	11/1/2023 1:16 PM
Details	340B ID	Update	New Registration		DSH420036B	11/1/2023 1:16 PM
Details	Entity Name	Update	New Registration	MUSC HEALTH LANCASTER MEDICAL CENTER	MUSC Health Lancaster Medical Center	11/1/2023 1:16 PM
Details	Entity Subname	Update	New Registration	LAN - Physical Therapy Indian Land (LMC)(CC001531)	LAN - Physical Therapy Indian Land (LMC)(CC001531) - Physical Therapy	11/1/2023 1:16 PM
Dates	Participating Approval Date	Update	New Registration		11/1/2023 1:16:14 PM	11/1/2023 1:16 PM
Details	State	Update	New Registration	Pending	Approved	11/1/2023 1:16 PM
Dates	Signed By Date	Update	New Registration		10/16/2023 10:28:35 AM	11/1/2023 1:16 PM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	11/1/2023 1:16 PM
Addresses	Main Address	Insert	New Registration		2816 World Reach Dr Fort Mill, SC 29707	10/13/2023 5:11 PM
Addresses	Billing Address	Insert	New Registration		MUSC HEALTH LANCASTER MEDICAL CENTER 800 WEST MEETING STREET LANCASTER, SC 29720	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		254485	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		SC	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		441901	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		SC	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		7Z1196	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		SC	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		003162150A	10/13/2023 5:11 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		GA	10/13/2023 5:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1073605879	10/13/2023 5:11 PM
Medicaid Billing	NPI: State	Insert	New Registration		NC	10/13/2023 5:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1144793654	10/13/2023 5:11 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	10/13/2023 5:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1255804753	10/13/2023 5:11 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	10/13/2023 5:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1528739810	10/13/2023 5:11 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	10/13/2023 5:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1700359205	10/13/2023 5:11 PM
Medicaid Billing	NPI: State	Insert	New Registration		SC	10/13/2023 5:11 PM
Contacts	Authorizing Official	Insert	New Registration		Goodlett, Lisa Chief Financial Officer Medical University Hospital Authority 8437924775	10/13/2023 5:11 PM
Contacts	Primary Contact	Insert	New Registration		Kushner, Gail M Director, 340B MEDICAL UNIVERSITY HOSPITAL AUTHORITY 8439852371	10/13/2023 5:11 PM
Details	Assistance Received From Date	Insert	New Registration			10/13/2023 5:11 PM
Details	Assistance Received To Date	Insert	New Registration			10/13/2023 5:11 PM
Details	Last Recertification Date	Insert	New Registration			10/13/2023 5:11 PM
Details	Grant Number	Insert	New Registration			10/13/2023 5:11 PM
Details	340B ID	Insert	New Registration			10/13/2023 5:11 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/13/2023 5:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/13/2023 5:11 PM
Details	Medicare Provider Number	Insert	New Registration		420036	10/13/2023 5:11 PM
Details	Entity Name	Insert	New Registration		MUSC HEALTH LANCASTER MEDICAL CENTER	10/13/2023 5:11 PM
Details	NOFO Number	Insert	New Registration			10/13/2023 5:11 PM
Details	Program Code	Insert	New Registration		DSH	10/13/2023 5:11 PM
Details	Entity Subname	Insert	New Registration		LAN - Physical Therapy Indian Land (LMC)(CC001531)	10/13/2023 5:11 PM
Dates	Participating Approval Date	Insert	New Registration			10/13/2023 5:11 PM
Details	State	Insert	New Registration		Pending	10/13/2023 5:11 PM
Dates	Registration Date	Insert	New Registration		10/13/2023 5:11:10 PM	10/13/2023 5:11 PM
Dates	Signed By Date	Insert	New Registration			10/13/2023 5:11 PM
Dates	Start Date	Insert	New Registration			10/13/2023 5:11 PM
Terminations	Termination Comments	Insert	New Registration			10/13/2023 5:11 PM
Terminations	Termination Date	Insert	New Registration			10/13/2023 5:11 PM
Terminations	Termination Effective Date	Insert	New Registration			10/13/2023 5:11 PM
Terminations	Termination Reason	Insert	New Registration			10/13/2023 5:11 PM