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DSH420078J Prisma Health GREENVILLE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
Prisma Health GREENVILLE MEMORIAL HOSPITAL
Subdivision Name
Prisma Health Cross Creek Surgery Center-ANES
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH420078J
Medicare Provider Number
420078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/18/2012
Participating Start Date
1/1/2013
Participating Approval Date
12/21/2012
Last Recertification Date
9/1/2023
Termination Date
Termination Reason
10/1/2024
Other
Contacts
Authorizing Official
Prisma Greenville Memorial
Barrett Ludley, CFO
(864) 455-6405
Primary Contact
Prisma Health
Abigail Bouknight, Manager 340B
(803) 920-3041
Addresses
Street Address
9 Doctors Drive
Greenville, SC 29605
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/21/12 Hospital was required by OPA to split original registration into more than one, which is why this registration was submitted after the deadline and signed by the contact person.
12/21/2012
May 2025
May 2025
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