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DSH420018 PRISMA HEALTH RICHLAND HOSPITAL (Active)
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Main Details
Name
PRISMA HEALTH RICHLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420018
Medicare Provider Number
420018
Additional Details
Current Program Status
Active
Registration Date
7/16/2008
Participating Start Date
8/1/1993
Participating Approval Date
7/16/2008
Last Recertification Date
8/21/2024
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
5 Richland Medical Park Drive
COLUMBIA, SC 29203
Billing Address
Prisma Health
PO Box 402121
Atlanta, GA 30384
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/24/12 Name change to match Medicare Cost Report JH
10/24/2012
10/3/12 Updated hospitals main address from 10 to 5 and removed child sites that were listed as pharmacies and appropriate addresses listed for shipping addresses added.4/28/05 NEW MED # (WAS 4207468); 6/15/04 ADDR CH (WAS FIVE RICHLAND MEDICAL PARK), ADDED MED #
10/03/2012
4/28/05 NEW MED # (WAS 4207468); 6/15/04 ADDR CH (WAS FIVE RICHLAND MEDICAL PARK), ADDED MED #
07/16/2008
May 2025
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