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DSH420004FB MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Active)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
Radiology - Diagnositc - CC - CT
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004FB
Medicare Provider Number
420004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2021
Participating Start Date
7/1/2021
Participating Approval Date
5/4/2021
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Medical University Hospital Authority
Thomas C Crawford, Chief Operating Officer
(843) 792-8775
Primary Contact
MUSC Health
Sharelle Brown, Executive System Director Pharmacy Business and Finance
(248) 396-8085
Addresses
Street Address
2250 Mall Drive
Floor 1
North Charleston, SC 29406
Billing Address
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
PO Box 31244
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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