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DSH420018V PRISMA HEALTH RICHLAND HOSPITAL (Active)
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Main Details
Name
PRISMA HEALTH RICHLAND HOSPITAL
Subdivision Name
Prisma Health Pediatric Pulmonology - Pulmonology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420018V
Medicare Provider Number
420018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2024
Participating Start Date
7/1/2024
Participating Approval Date
6/4/2024
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Prisma Health
William Anthony Jackson, Market CEO Midlands
(803) 389-6598
Primary Contact
Prisma Health
Abigail Bouknight, Manager 340B
(803) 920-3041
Addresses
Street Address
9 Richland Medical Park Drive
Suite 505
Columbia, SC 29203
Billing Address
Prisma Health
PO Box 402121
Atlanta, GA 30384
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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