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WAL-MART PHARMACY 10-1183
DSH420086 PRISMA HEALTH BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
PRISMA HEALTH BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420086
Entity Address
1333 Taylor Street
COLUMBIA, SC 29202
Medicare Provider Number
420086
Participating Start Date
7/1/2006
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1183
Pharmacy Address
2401 AUGUSTA ROAD
WEST COLUMBIA, SC 29169
Pharmacy Comments
Contract Details
Approval Date
2/15/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James M. Bridges, Acute Care Executive
(803) 296-5174
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/10/2013
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