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DSH420038 GHS Laurens County Memorial Hospital (Terminated)
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Main Details
Name
GHS Laurens County Memorial Hospital
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH420038
Medicare Provider Number
420038
Additional Details
Current Program Status
Terminated
Registration Date
6/15/2010
Participating Start Date
7/1/2010
Participating Approval Date
6/16/2010
Last Recertification Date
8/12/2015
Termination Date
Termination Reason
10/1/2015
Change of covered entity type
Contacts
Authorizing Official
Richard D'Alberto, Campus President
(864) 833-9150
Primary Contact
Laurens County Memorial Hospital
Lee Dailey, Director of Pharmacy
(864) 833-9183
Addresses
Street Address
22725 HWY 76 EAST
CLINTON, SC 29325
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/16/10 - DOC RECD TO CONFIRM ELIG DSH ADJ %
06/16/2010
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