340B Drug Pricing Program Database
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DSH420078AU Prisma Health GREENVILLE MEMORIAL HOSPITAL (Active)
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Main Details
Name
Prisma Health GREENVILLE MEMORIAL HOSPITAL
Subdivision Name
Prisma Health GI Lab Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH420078AU
Medicare Provider Number
420078
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/17/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/1/2017
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Prisma Greenville Memorial
Barrett Ludley, CFO
(864) 455-6405
Primary Contact
Prisma Health
Abigail Bouknight, Manager 340B
(803) 920-3041
Addresses
Street Address
890 West Faris Road
200
Greenville, SC 29605
Billing Address
Prisma Health
PO Box 402121
Atlanta, GA 30384
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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