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DSH420078AJ GREENVILLE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
GREENVILLE MEMORIAL HOSPITAL
Subdivision Name
ccc - a dept of GMH, Eastside
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH420078AJ
Medicare Provider Number
420078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/11/2013
Last Recertification Date
8/24/2016
Termination Date
Termination Reason
1/1/2017
Site closure
Contacts
Authorizing Official
Prisma Health Greenville Memorial
James Scott Agnew, CEO
(864) 455-5286
Primary Contact
Prisma Health Greenville Memorial Medical Campus
sam carros, pharmacy manager
(864) 522-3821
Addresses
Street Address
65 International Drive
Greenville, SC 29615
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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