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DSH420106 PH BAPTIST PARKRIDGE HOSPITAL (Terminated)
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Main Details
Name
PH BAPTIST PARKRIDGE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH420106
Medicare Provider Number
420106
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/20/2024
Last Recertification Date
8/22/2024
Termination Date
Termination Reason
4/1/2025
DSH percentage below statutory minimum
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
400 PALMETTO HEALTH PARKWAY
COLUMBIA, SC 29212
Billing Address
Prisma Health
PO Box 402121
Atlanta, GA 30384
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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