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ACCREDO HEALTH GROUP, INC.
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
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Bundy, Chief Executive Officer
(803) 296-5782
Contract Pharmacy Representative
Accredo Health Group, Inc.
Travis Behrens, Lead Director, 340B Client Sales
(407) 988-7044
Signed By Date
10/16/2023
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