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DSH420004CM MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Terminated)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
Acute Directional Unit
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004CM
Medicare Provider Number
420004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/9/2015
Last Recertification Date
8/20/2021
Termination Date
Termination Reason
4/1/2022
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Medical University Hospital Authority
Thomas C Crawford, Chief Operating Officer
(843) 792-8775
Primary Contact
MUSC
Kelly Crowley, Director
(843) 792-1009
Addresses
Street Address
25 Courtenay Dr.
Charleston, SC 29425
Billing Address
Medical University of South Carolina
169 Ashley Ave
Charleston, SC 29425
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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