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CORAM HEALTHCARE/CAROLINA HOME THERAPEUT
DSH420078 Prisma Health GREENVILLE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
Prisma Health GREENVILLE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420078
Entity Address
701 GROVE ROAD
GREENVILLE, SC 29605
Medicare Provider Number
420078
Participating Start Date
4/1/1999
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CORAM HEALTHCARE/CAROLINA HOME THERAPEUT
Pharmacy Address
720 GRACERN ROAD
SUITE 123
COLUMBIA, SC 29210
Pharmacy Comments
Contract Details
Approval Date
7/5/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Johnson, Regional COO, Prisma Health- Upstate
(864) 455-6250
Contract Pharmacy Representative
Bryan Mayer, Branch Manager
(803) 731-5076
Signed By Date
7/5/2017
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