340B Drug Pricing Program Database
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DSH420018Q PRISMA HEALTH RICHLAND HOSPITAL (Terminated)
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Main Details
Name
PRISMA HEALTH RICHLAND HOSPITAL
Subdivision Name
PSC Shandon
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420018Q
Medicare Provider Number
420018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2013
Participating Start Date
4/1/2013
Participating Approval Date
2/28/2013
Last Recertification Date
9/10/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Prisma Health Richland Hospital
Robert Haarbauer Cofield, Chief Executive Officer
(803) 434-3750
Primary Contact
Prisma Health
Jennifer Davis Bair, Director of Pharmacy
(803) 434-3769
Addresses
Street Address
PSC Shandon
1100 Shirley Street
Columbia, SC 29205
Billing Address
Prisma Health SeniorCare Pharmacy
1308 Laurel Street
2nd Floor
Columbia, SC 29201
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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