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DSH420018J Palmetto Richland (Terminated)
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Main Details
Name
Palmetto Richland
Subdivision Name
Senior Primary Care - Parkridge
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420018J
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
9/6/2018
Termination Date
Termination Reason
10/1/2019
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
100 Palmetto Health Parkway
Suite G-100
Columbia, SC 29212
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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