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DSH420004CR MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Terminated)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
Rad Peds After Hours Clinc N Area
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004CR
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
9/11/2020
Termination Date
Termination Reason
7/1/2021
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Medical University Hospital Authority
Thomas C Crawford, Chief Operating Officer
(843) 792-8775
Primary Contact
Medical University Hospital Authority
Alan Knudsen, 340B Manager
(843) 792-5691
Addresses
Street Address
2750 Dantzler Dr.
Unit 102
North Charleston, SC 29406
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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