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DSH420020F GEORGETOWN MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
GEORGETOWN MEMORIAL HOSPITAL
Subdivision Name
Tidelands Health Cancer Care Network at Myrtle Beach
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420020F
Medicare Provider Number
420020
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2016
Participating Start Date
3/15/2022
Participating Approval Date
4/12/2016
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
4/1/2024
DSH percentage below statutory minimum
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
Addresses
Street Address
1220 21st Ave N
Myrtle Beach, SC 29577-7401
Billing Address
Tidelands Health Cancer Care Network at Myrtle Beach
606 BLACK RIVER RD
-
Georgetown, SC 29440-3304
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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