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DSH420018D Palmetto Richland (Terminated)
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Main Details
Name
Palmetto Richland
Subdivision Name
Palmetto Health Ortho Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420018D
Medicare Provider Number
420018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2012
Participating Start Date
1/1/2013
Participating Approval Date
12/17/2012
Last Recertification Date
12/5/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Prisma Health Richland Hospital
Paul Johnson, Interim Chief Executive Officer
(803) 434-4500
Primary Contact
Prisma Health
JENNIFER DAVIS BAIR, System Director of Pharmacy
(803) 434-3769
Addresses
Street Address
1801 Sunset Drive
1st Floor
Columbia, SC 29203
Billing Address
Palmetto Health Pharmacy 10MP
10 Medical Park Drive
Columbia, SC 29203
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/17/12 David Lee has the authority to act on behalf of the hospital and enter the hospital into a legal agreement with the Federal Government.
12/17/2012
June 2025
June 2025
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