340B Drug Pricing Program Database
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DSH420078AZ Prisma Health GREENVILLE MEMORIAL HOSPITAL (Active)
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Main Details
Name
Prisma Health GREENVILLE MEMORIAL HOSPITAL
Subdivision Name
Gastroenterology and Liver Center - Gastroenterology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH420078AZ
Medicare Provider Number
420078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/10/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/10/2024
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Prisma Greenville Memorial
Barrett Ludley, CFO
(864) 455-6405
Primary Contact
Prisma Health
Abigail Bouknight, Manager 340B
(803) 920-3041
Addresses
Street Address
890 West Faris Road
100
Greenville, SC 29605-4285
Billing Address
Prisma Health
PO Box 402121
Atlanta, GA 30384
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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