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GREENVILLE HEALTH CORPORATION
DSH420086 PRISMA HEALTH BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
PRISMA HEALTH BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH420086
Entity Address
1333 Taylor Street
COLUMBIA, SC 29202
Medicare Provider Number
420086
Participating Start Date
7/1/2006
Last Recertification Date
8/21/2024
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
1/17/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/14/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Benjamin Martin Cunningham, System VP - Finance
(803) 296-2448
Contract Pharmacy Representative
Upstate Pharmacy
Steve Ranck, Director of Pharmacy
(864) 522-1708
Signed By Date
1/17/2018
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