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DSH420004LB MEDICAL UNIVERSITY HOSPITAL AUTHORITY (Terminated)
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Main Details
Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
MCP - ORBG - Cardiology (Dr. Hutto & Dr. King) - Cardiology - CC004838
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH420004LB
Medicare Provider Number
420004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2023
Participating Start Date
4/26/2023
Participating Approval Date
4/26/2023
Last Recertification Date
8/14/2023
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
2664 Saint Matthews Road
Orangeburg, SC 29118
Billing Address
Medical University Hospital Authority
3000 Saint Matthews Road
Pharmacy Department
Ground Floor
Orangeburg, SC 29118
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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