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DSH420020E GEORGETOWN MEMORIAL HOSPITAL (Terminated)
Main Details
Name
GEORGETOWN MEMORIAL HOSPITAL
Subdivision Name
TIDELANDS HEALTH WOUND CARE AND INFUSION CENTER AT MURRELLS INLET/TIDELANDS HEALTH ECHO/VASCULAR LAB AT MURRELLS INLET
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420020E
Medicare Provider Number
420020
Outpatient Facility Provider Number
Contacts
Authorizing Official
Georgetown Memorial Hospital
Gayle Lynn Resetar, COO
(843) 527-7100
Primary Contact
Georgetown Memorial Hospital
Darrell Willm, Pharmacy Director
(843) 457-8351
Additional Details
Current Program Status
Terminated
Registration Date
4/2/2015
Participating Start Date
3/15/2022
Participating Approval Date
6/10/2015
Last Recertification Date
9/6/2023
Termination Date
4/1/2024
Termination Reason
DSH percentage below statutory minimum
Addresses
Street Address
4367 RIVERWOOD DR UNIT 140
MURRELLS INLET, SC 29576-4381
Billing Address
TIDELANDS HEALTH WOUND CARE AND INFUSION CENTER AT MURRELLS INLET/TIDELANDS HEALTH ECHO/VASCULAR LAB
606 BLACK RIVER RD
GEORGETOWN, SC 29440-3304
Comments
Medicaid Billing
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Contract Pharmacies
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