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DSH420004DT MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Terminated)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
Pediatric Emergency Services - Pediatric Emergency Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004DT
Medicare Provider Number
420004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/14/2019
Last Recertification Date
8/15/2023
Termination Date
Termination Reason
4/1/2024
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Medical University Hospital Authority
Thomas C Crawford, Chief Operating Officer
(843) 792-8775
Primary Contact
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Gail M Kushner, Director, 340B
(843) 985-2371
Addresses
Street Address
167 Ashley Ave.
Charleston, SC 29425
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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