340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH420020A GEORGETOWN MEMORIAL HOSPITAL (Terminated)
Print
Main Details
Name
GEORGETOWN MEMORIAL HOSPITAL
Subdivision Name
Tidelands Health Pain Management Services at Georgetown
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420020A
Medicare Provider Number
420020
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/30/2008
Participating Start Date
3/15/2022
Participating Approval Date
6/2/2008
Last Recertification Date
9/19/2022
Termination Date
Termination Reason
1/1/2023
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Georgetown Memorial Hospital
Gayle Lynn Resetar, COO
(843) 527-7100
Primary Contact
Georgetown Memorial Hospital
Darrell Willm, Pharmacy Director
(843) 457-8351
Addresses
Street Address
219 Church St
GEORGETOWN, SC 29440-2403
Billing Address
Tidelands Health Pain Management Services at Georgetown
606 Black River Rd
Georgetown, SC 29440-3304
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
6/8/15 Hospital previously participated as DSH420020A from 7/1/2008-1/1/2014 and RRC420020-01 from 1/1/2014-6/30/2015; converted to a DSH hospital effective 7/1/2015
06/08/2015
June 2025
June 2025
week
S
M
T
W
T
F
S
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
24
8
9
10
11
12
13
14
25
15
16
17
18
19
20
21
26
22
23
24
25
26
27
28
27
29
30
1
2
3
4
5
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session