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DSH420004CX MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Terminated)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
Outpatient Ambulatory Care - Amb care clinics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004CX
Medicare Provider Number
420004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/20/2018
Last Recertification Date
8/20/2021
Termination Date
Termination Reason
4/1/2022
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Medical University Hospital Authority
Thomas C Crawford, Chief Operating Officer
(843) 792-8775
Primary Contact
MUSC
Kelly Crowley, Director
(843) 792-1009
Addresses
Street Address
135 Rutledge Ave
Charleston, SC 29425
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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