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DSH420069 CLARENDON MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
CLARENDON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420069
Medicare Provider Number
420069
Additional Details
Current Program Status
Terminated
Registration Date
9/4/2007
Participating Start Date
1/1/2005
Participating Approval Date
9/4/2007
Last Recertification Date
8/28/2015
Termination Date
Termination Reason
10/1/2016
DSH percentage below statutory minimum
Contacts
Authorizing Official
Paul Schumacher, ACTING CEO
(803) 435-3239
Primary Contact
Jil T. Hopkins, 340B DIRECTOR
(803) 433-3055
Addresses
Street Address
10 HOSPITAL STREET
MANNING, SC 29102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/12/10 SHIP TO & MEDI ID ADDED.03/28/11 REMOVED MEDICAID#(WAS #757306 AND #722205)
04/20/2011
May 2025
May 2025
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