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DSH420020D GEORGETOWN MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
GEORGETOWN MEMORIAL HOSPITAL
Subdivision Name
GEORGETOWN ENDOSCOPY CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420020D
Medicare Provider Number
420020
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/2/2015
Participating Start Date
7/1/2015
Participating Approval Date
6/10/2015
Last Recertification Date
11/21/2017
Termination Date
Termination Reason
7/1/2018
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Georgetown Memorial Hospital
Gayle Lynn Resetar, COO
(843) 527-7100
Primary Contact
Georgetown Memorial Hospital
AMBROSE HOLLIDAY, DIRECTOR OF OUTPATIENT PHARMACY SERVICES
(843) 527-7497
Addresses
Street Address
2361 N. FRASER STREET
GEORGETOWN, SC 29440
Billing Address
GEORGETOWN ENDOSCOPY CENTER
606 BLACK RIVER ROAD
GEORGETOWN, SC 29440
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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