Covered Entity Details

RRC250040-33 SINGING RIVER HEALTH SYSTEM (Active) - information as of 4/25/2025 6:31:58 PM

Main Details

Name

SINGING RIVER HEALTH SYSTEM

Subdivision Name

SINGING RIVER SURGICAL SERVICES - Surgical Services Clinic

Type

Rural Referral Center

Rural

Yes

340B ID

RRC250040-33

Medicare Provider Number

250040

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/3/2024

Participating Start Date

7/1/2024

Participating Approval Date

5/30/2024

Last Recertification Date

8/30/2024

Contacts

Authorizing Official

Singing River Health System
Heath Allen Thompson, Administrator Ancillary Services
(228) 818-1191

Primary Contact

Singing River Health System
Lisa D Fratesi, Executive Director of Pharmacy
(662) 347-0066

Addresses

Street Address

2525 TELEPHONE RD
PASCAGOULA, MS 39567-3202

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MS	200000645,100008396	1083893937,1124136593
AL	HOS004P,004672562	1083893937,1124136593
FL	004672562,095912000	1083893937,1124136593
LA	004672562,1732524	1083893937,1124136593

Shipping Addresses

Shipping Address 1

Pascagoula Hospital
2809 Denny Ave
Pascagoula, MS 39581

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC250040-01	Child	RRC	SINGING RIVER HEALTH SYSTEM	SINGING RIVER HEALTH SYSTEM - Behavioral Health Clinic	4502 LT EUGENE J MAJURE DR	PASCAGOULA	MS	Active
RRC250040-02	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Heart Failure Clinic	1175 Ocean Springs Road	Ocean Springs Hospital	MS	Active
RRC250040-03	Child	RRC	SINGING RIVER HEALTH SYSTEM	SINGING RIVER HEALTH SYSTEM - Medical Clinic- Vancleave	11700 HIGHWAY 57	VANCLEAVE	MS	Active
RRC250040-04	Child	RRC	SINGING RIVER HEALTH SYSTEM	Medical Park Ocean Springs - MRI	3535 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-05	Child	RRC	SINGING RIVER HEALTH SYSTEM	Medical Park Pascagoula - MRI	3101 Denny Ave	Pascagoula	MS	Active
RRC250040-06	Child	RRC	SINGING RIVER HEALTH SYSTEM	Cancer Services - Regional Cancer Center- Ocean Springs	3535 Bienville Blvd	Ocean Springs	MS	Approved
RRC250040-07	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Cardiac Catheterization Services	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-08	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Imaging Services	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-09	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Anesthesia Services	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-10	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Emergency Department	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-11	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Respiratory Therapy Services	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-12	Child	RRC	SINGING RIVER HEALTH SYSTEM	Medical Park Pascagoula - Cat Scan	3101 Denny Ave	Pascagoula	MS	Active
RRC250040-13	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Surgical Services/Infusion	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-14	Child	RRC	SINGING RIVER HEALTH SYSTEM	SINGING RIVER HEALTH SYSTEM - Medical Clinic- Hurley	7001 HWY 614	HURLEY	MS	Active
RRC250040-15	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Woundcare/Hyperbarics	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-16	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Non Invasive Cardiology	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-17	Child	RRC	SINGING RIVER HEALTH SYSTEM	Medical Park Ocean Springs - Cat Scan	3535 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-18	Child	RRC	SINGING RIVER HEALTH SYSTEM	Medical Park Ocean Springs - PET CT	3535 Bienville Blvd	Ocean Springs	MS	Active
RRC250040-19	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Medical Clinics - Medical Clinic- Ocean Springs	3099 Bienville Blvd	Ocean Springs	MS	Active
RRC250040-20	Child	RRC	SINGING RIVER HEALTH SYSTEM	SINGING RIVER HEALTH SYSTEM - Medical Clinic- Woolmarket	13034B SHRINERS BLVD	BILOXI	MS	Terminated
RRC250040-21	Child	RRC	SINGING RIVER HEALTH SYSTEM	Specialty Medical Clinics - Rheumatology Services	3603 Bienville Blvd, Suite 100	Ocean Springs	MS	Terminated
RRC250040-22	Child	RRC	SINGING RIVER HEALTH SYSTEM	Pascagoula Medical Park - Nuc Med	3101 Denny Ave	Pascagoula	MS	Terminated
RRC250040-23	Child	RRC	SINGING RIVER HEALTH SYSTEM	Specialty Medical Clinics - Endocrinology Services	3635 Bienville Blvd, Suite B	Ocean Springs	MS	Approved
RRC250040-24	Child	RRC	SINGING RIVER HEALTH SYSTEM	Specialty Medical Clinics - Rheumatology Services	3101 Denny Ave, Suite 240	Pascagoula	MS	Approved
RRC250040-25	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Medical Clinics - Medical Clinic- Pascagoula	2819 Denny Ave	Pascagoula	MS	Active
RRC250040-26	Child	RRC	SINGING RIVER HEALTH SYSTEM	Specialty Clinics - Neuroscience Center	3603 Bienville Blvd, Suite 102	Ocean Springs	MS	Approved
RRC250040-27	Child	RRC	SINGING RIVER HEALTH SYSTEM	Hospice Services - Hospice of Light- Lucedale	53 Dewey Street	Lucedale	MS	Terminated
RRC250040-28	Child	RRC	SINGING RIVER HEALTH SYSTEM	Hospice Care - Hospice of Light- Ocean Springs	1121 Ocean Springs Rd	Ocean Springs	MS	Active
RRC250040-29	Child	RRC	SINGING RIVER HEALTH SYSTEM	Specialty Medical Clinics - Pulmonary Services	3635 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-30	Child	RRC	SINGING RIVER HEALTH SYSTEM	Specialty Medical Clinic - Pulmonary Services	3101 Denny Ave, suite 240	Pascagoula	MS	Approved
RRC250040-31	Child	RRC	SINGING RIVER HEALTH SYSTEM	CEDAR LAKE MEDICAL CLINIC - Primary Care	967 CEDAR LAKE RD	BILOXI	MS	Active
RRC250040-32	Child	RRC	SINGING RIVER HEALTH SYSTEM	SINGING RIVER SURGICAL SERVICES - Surgical Services Clinic	1124 OAKLEIGH RD	OCEAN SPRINGS	MS	Active
RRC250040-33	Child	RRC	SINGING RIVER HEALTH SYSTEM	SINGING RIVER SURGICAL SERVICES - Surgical Services Clinic	2525 TELEPHONE RD	PASCAGOULA	MS	Active
RRC250040-34	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Clinics - ENT	3101 Denny Ave	Pascagoula	MS	Active
RRC250040-35	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River - Medical Clinic Biloxi	131 Reynoir St.	Biloxi	MS	Active
RRC250040-36	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Nuc Med	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-37	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - Cat Scan	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-38	Child	RRC	SINGING RIVER HEALTH SYSTEM	Ocean Springs Hospital - MRI	3109 Bienville Blvd	Ocean Springs	MS	Terminated
RRC250040-39	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Colorectal Surgery Clinic - Colorectal	3101 Denny Avenue	Pascagoula	MS	Active
RRC250040-40	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Health Regional Digestive Specialist - Gastroenterology	5411 Hospital Street	Pascagoula	MS	Approved
RRC250040-41	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Medical Clinics Cowan Road - Primary Care	250 Cowan Road	Gulfport	MS	Approved
RRC250040-42	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Gulfport Cancer Center - Oncology	15200 Community Road	Gulfport	MS	Approved
RRC250040-43	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Gulfport Digestive Health - Gastroenterology	15190 Community Road	Gulfport	MS	Approved
RRC250040-44	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Orthopedics Ocean Springs - Orthopedics	3603 Bienville Blvd	Ocean Springs	MS	Approved
RRC250040-45	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Gulfport - Wound Care Services	15190 Community Road	Gulfport	MS	Approved
RRC250040-46	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Clinics Surgical Services - Surgical Services	15190 Community Road	Gulfport	MS	Approved
RRC250040-47	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Gulfport Ortthopedic Clinic - Orthopedics	15190 Community Road	Gulfport	MS	Approved
RRC250040-48	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Medical Clinics Orange Grove - Primary Care	12121 US Highway 49	Gulfport	MS	Approved
RRC250040-49	Child	RRC	SINGING RIVER HEALTH SYSTEM	Outpatient Clinical Services Ocean Springs - Outpatient Clinical Services	3109 Bienville Blvd	Ocean Springs	MS	Approved
RRC250040-50	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Regional Digestive Specialist - Ocean Springs Gastroenterology	1270 Ocean Springs Road	Oean Springs	MS	Approved
RRC250040-51	Child	RRC	SINGING RIVER HEALTH SYSTEM	Singing River Specialty Clinics Specialty Clinics - Specialty Clinics	967 Cedar Lake	Biloxi	MS	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Recertification		1124136593	8/30/2024 9:36 AM
Medicaid Billing	NPI: State	Insert	Recertification		MS	8/30/2024 9:36 AM
Details	Last Recertification Date	Update	Recertification		8/30/2024 9:36:37 AM	8/30/2024 9:36 AM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Thompson, Heath Allen Administrator Ancillary Services Singing River Health System 2288181191	5/30/2024 12:34 PM
Details	340B ID	Update	New Registration		RRC250040-33	5/30/2024 12:34 PM
Details	Entity Subname	Update	New Registration	SINGING RIVER SURGICAL SERVICES	SINGING RIVER SURGICAL SERVICES - Surgical Services Clinic	5/30/2024 12:34 PM
Dates	Participating Approval Date	Update	New Registration		5/30/2024 12:34:27 PM	5/30/2024 12:34 PM
Details	State	Update	New Registration	Pending	Approved	5/30/2024 12:34 PM
Dates	Signed By Date	Update	New Registration		4/3/2024 2:02:17 PM	5/30/2024 12:34 PM
Dates	Start Date	Update	New Registration		7/1/2024 12:00:00 AM	5/30/2024 12:34 PM
Addresses	Main Address	Insert	New Registration		2525 TELEPHONE RD PASCAGOULA, MS 39567-3202	4/3/2024 2:02 PM
Addresses	Shipping Address	Insert	New Registration		Pascagoula Hospital 2809 Denny Ave Pascagoula, MS 39581	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		200000645	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100008396	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HOS004P	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		004672562	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		004672562	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		095912000	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		004672562	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1732524	4/3/2024 2:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	4/3/2024 2:02 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	4/3/2024 2:02 PM
Medicaid Billing	NPI: State	Insert	New Registration		MS	4/3/2024 2:02 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	4/3/2024 2:02 PM
Medicaid Billing	NPI: State	Insert	New Registration		AL	4/3/2024 2:02 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	4/3/2024 2:02 PM
Medicaid Billing	NPI: State	Insert	New Registration		AL	4/3/2024 2:02 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	4/3/2024 2:02 PM
Medicaid Billing	NPI: State	Insert	New Registration		FL	4/3/2024 2:02 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	4/3/2024 2:02 PM
Medicaid Billing	NPI: State	Insert	New Registration		FL	4/3/2024 2:02 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	4/3/2024 2:02 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	4/3/2024 2:02 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	4/3/2024 2:02 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	4/3/2024 2:02 PM
Contacts	Authorizing Official	Insert	New Registration		Thompson, Heath Allen Administrator Ancillary Services Singing River Health System 2288181191	4/3/2024 2:02 PM
Contacts	Primary Contact	Insert	New Registration		Fratesi, Lisa D Executive Director of Pharmacy Singing River Health System 6623470066	4/3/2024 2:02 PM
Details	Assistance Received From Date	Insert	New Registration			4/3/2024 2:02 PM
Details	Assistance Received To Date	Insert	New Registration			4/3/2024 2:02 PM
Details	Last Recertification Date	Insert	New Registration			4/3/2024 2:02 PM
Details	Grant Number	Insert	New Registration			4/3/2024 2:02 PM
Details	340B ID	Insert	New Registration			4/3/2024 2:02 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/3/2024 2:02 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/3/2024 2:02 PM
Details	Medicare Provider Number	Insert	New Registration		250040	4/3/2024 2:02 PM
Details	Entity Name	Insert	New Registration		SINGING RIVER HEALTH SYSTEM	4/3/2024 2:02 PM
Details	NOFO Number	Insert	New Registration			4/3/2024 2:02 PM
Details	Program Code	Insert	New Registration		RRC	4/3/2024 2:02 PM
Details	Entity Subname	Insert	New Registration		SINGING RIVER SURGICAL SERVICES	4/3/2024 2:02 PM
Dates	Participating Approval Date	Insert	New Registration			4/3/2024 2:02 PM
Details	State	Insert	New Registration		Pending	4/3/2024 2:02 PM
Dates	Registration Date	Insert	New Registration		4/3/2024 2:02:12 PM	4/3/2024 2:02 PM
Dates	Signed By Date	Insert	New Registration			4/3/2024 2:02 PM
Dates	Start Date	Insert	New Registration			4/3/2024 2:02 PM
Terminations	Termination Comments	Insert	New Registration			4/3/2024 2:02 PM
Terminations	Termination Date	Insert	New Registration			4/3/2024 2:02 PM
Terminations	Termination Effective Date	Insert	New Registration			4/3/2024 2:02 PM
Terminations	Termination Reason	Insert	New Registration			4/3/2024 2:02 PM