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PALMETTO HEALTH PHARMACY 10MP
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
PALMETTO HEALTH PHARMACY 10MP
Pharmacy Address
14 RICHLAND MEDICAL PARK DR
STE 210
COLUMBIA, SC 29203-6877
Pharmacy Comments
Contract Details
Approval Date
7/13/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
James M. Bridges, Acute Care Executive
(803) 296-5174
Contract Pharmacy Representative
Palmetto Health
Dave Amsden, Director of Pharmacy Services
(803) 434-2535
Signed By Date
7/13/2016
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