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DSH420004 MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Active)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
MEDICAL UNIVERSITY HOSPITAL
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004
Medicare Provider Number
420004
Additional Details
Current Program Status
Active
Registration Date
9/4/2007
Participating Start Date
12/1/1992
Participating Approval Date
9/4/2007
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
169 ASHLEY AVENUE
CHARLESTON, SC 29425
Billing Address
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
PO Box 31244
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/22/11, added ship to addr.(at 230 albemarle) 1/21/09 UPDATED ADDR (WAS 171 ASHLEY AVE.) 2/24/04 UPDATED MEDICAID # (WAS 702798, 708630)
11/22/2011
1/21/09 UPDATED ADDR (WAS 171 ASHLEY AVE.) 2/24/04 UPDATED MEDICAID # (WAS 702798, 708630)
12/02/2010
May 2025
May 2025
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