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ACCREDO HEALTH GROUP INC
DSH420004 MEDICAL UNIVERSITY HOSPITAL AUTHORITY
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Covered Entity Details
Entity Name
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Subdivision Name
MEDICAL UNIVERSITY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH420004
Entity Address
169 ASHLEY AVENUE
CHARLESTON, SC 29425
Medicare Provider Number
420004
Participating Start Date
12/1/1992
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP INC
Pharmacy Address
1620 CENTURY CENTER PKWY
# 109
MEMPHIS, TN 38134-8849
Pharmacy Comments
Contract Details
Approval Date
7/17/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen A. Hargett, CFO
(843) 792-6461
Contract Pharmacy Representative
Accredo Health Group
Mark Leeper, Senior Director
(317) 240-8383
Signed By Date
7/17/2015
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