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DSH420078 Prisma Health GREENVILLE MEMORIAL HOSPITAL (Active)
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Main Details
Name
Prisma Health GREENVILLE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH420078
Medicare Provider Number
420078
Additional Details
Current Program Status
Active
Registration Date
10/19/2007
Participating Start Date
4/1/1999
Participating Approval Date
10/19/2007
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
701 GROVE ROAD
GREENVILLE, SC 29605
Billing Address
Prisma Health
PO Box 402121
Atlanta, GA 30384
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/5/12 ADDED MEDICAID #; 10/27/04 UPDATED ADDR (WAS PHARMACY AT 700 WEST FARIS ROAD);10/27/04 REMOVED MEDICAID # (WAS 717777)
03/05/2012
10/27/04 UPDATED ADDR (WAS PHARMACY AT 700 WEST FARIS ROAD);10/27/04 REMOVED MEDICAID # (WAS 717777)
01/12/2010
May 2025
May 2025
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