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GREENVILLE HEALTH CORPORATION
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
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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