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DSH420004BL MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Approved)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
North Star (Psych Outpt)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004BL
Medicare Provider Number
420004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/11/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/5/2025
Last Recertification Date
Contacts
Authorizing Official
Medical University Hospital Authority
Thomas C Crawford, Chief Operating Officer
(843) 792-8775
Primary Contact
MUSC Health
Sharelle Brown, Executive System Director Pharmacy Business and Finance
(248) 396-8085
Addresses
Street Address
67 President St
room PH534
Charleston, SC 29425
Billing Address
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
PO Box 31244
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 10/1/2013, Terminated 10/1/2024, Reinstatement 7/1/2025
05/02/2025
May 2025
May 2025
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