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PALMETTO HEALTH PHARMACY 10MP
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
PALMETTO HEALTH PHARMACY 10MP
Pharmacy Address
14 RICHLAND MEDICAL PARK DR
STE 210
COLUMBIA, SC 29203-6877
Pharmacy Comments
Contract Details
Approval Date
10/4/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Benjamin Martin Cunningham, System VP - Finance
(803) 296-2448
Contract Pharmacy Representative
Prisma Health
JENNIFER DAVIS BAIR, System Director of Pharmacy
(803) 434-3769
Signed By Date
10/4/2017
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