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GREENVILLE HEALTH CORPORATION
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
GREENVILLE HEALTH CORPORATION
Pharmacy Address
D/B/A PRISMA HEALTH SPECIALTY PHARMACY
845 S BUNCOMBE RD
STE D
GREER, SC 29650-2432
Pharmacy Comments
Contract Details
Approval Date
1/5/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Johnson, Regional COO, Prisma Health- Upstate
(864) 455-6250
Contract Pharmacy Representative
Upstate Pharmacy
Steve Ranck, Director of Pharmacy
(864) 522-1708
Signed By Date
1/5/2018
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