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LONGS MILLWOOD PHARMACY
DSH420018 PRISMA HEALTH RICHLAND HOSPITAL
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Covered Entity Details
Entity Name
PRISMA HEALTH RICHLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420018
Entity Address
5 Richland Medical Park Drive
COLUMBIA, SC 29203
Medicare Provider Number
420018
Participating Start Date
8/1/1993
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
LONGS MILLWOOD PHARMACY
Pharmacy Address
2801 MILLWOOD AVENUE
COLUMBIA, SC 29205
Pharmacy Comments
Contract Details
Approval Date
3/7/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/9/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David F. Lee, Director of Financial Forecasting
(803) 296-3632
Contract Pharmacy Representative
Long's Drugs
Christi Epps, PharmD
(404) 270-9242
Signed By Date
1/14/2013
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