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DSH420004AF MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Active)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
Family Medicine / Ellis Oaks
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004AF
Medicare Provider Number
420004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/26/2012
Participating Start Date
10/1/2012
Participating Approval Date
8/30/2012
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Medical University Hospital Authority
Thomas C Crawford, Chief Operating Officer
(843) 792-8775
Primary Contact
MUSC Health
Sharelle Brown, Executive System Director Pharmacy Business and Finance
(248) 396-8085
Addresses
Street Address
650 Ellis Oaks Avenue
Charleston, SC 29412
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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