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DSH420004T MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Terminated)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
Pediatric GI Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004T
Medicare Provider Number
420004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/26/2012
Participating Start Date
10/1/2012
Participating Approval Date
8/31/2012
Last Recertification Date
8/15/2023
Termination Date
Termination Reason
7/1/2024
Site closure
Contacts
Authorizing Official
Medical University Hospital Authority
Thomas C Crawford, Chief Operating Officer
(843) 792-8775
Primary Contact
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Gail M Kushner, Director, 340B
(843) 985-2371
Addresses
Street Address
135 Rutledge Avenue
Charleston, SC 29425
Billing Address
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
PO Box 31244
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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