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DSH420018G PRISMA HEALTH RICHLAND HOSPITAL (Active)
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Main Details
Name
PRISMA HEALTH RICHLAND HOSPITAL
Subdivision Name
Prisma Health Infusion Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420018G
Medicare Provider Number
420018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/11/2012
Participating Start Date
1/1/2013
Participating Approval Date
12/17/2012
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Prisma Health
William Anthony Jackson, Market CEO Midlands
(803) 389-6598
Primary Contact
Prisma Health
Abigail Bouknight, Manager 340B
(803) 920-3041
Addresses
Street Address
3010 Farrow Road
Suite 110
Columbia, SC 29203
Billing Address
Prisma Health
PO Box 402121
Atlanta, GA 30384
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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