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DSH420066A LAKE CITY COMMUNITY HOSPITAL (Terminated)
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Main Details
Name
LAKE CITY COMMUNITY HOSPITAL
Subdivision Name
PEE DEE FAMILY PRACTICE - LAKE CITY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH420066A
Medicare Provider Number
420066
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/4/2009
Participating Start Date
10/1/2009
Participating Approval Date
9/14/2009
Last Recertification Date
8/26/2015
Termination Date
Termination Reason
10/1/2015
Loss of qualifying grant/support
Contacts
Authorizing Official
H.E. MCCUTCHEON Jr., CEO/CFO
(843) 374-2036 Ext: 6120
Primary Contact
Sherry Galloway, Director of Pharmacy
(843) 374-6238
Addresses
Street Address
276 North Ron McNair Blvd
LAKE CITY, SC 29560
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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