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DSH420004BQ MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Terminated)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
Epilepsy Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004BQ
Medicare Provider Number
420004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/10/2014
Last Recertification Date
8/29/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Medical University Hospital Authority
Thomas C Crawford, Chief Operating Officer
(843) 792-8775
Primary Contact
Medical University Hospital Authority
Heather Easterling, Director, Pharmacy Services
(843) 792-5691
Addresses
Street Address
135 Rutledge Avenue
Charleston, SC 29425
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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