Covered Entity Details

DSH250123G SINGING RIVER GULFPORT (Terminated) - information as of 6/11/2025 11:37:08 PM

Main Details

Name

SINGING RIVER GULFPORT

Subdivision Name

Ocean Springs Cancer Center - Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH250123G

Medicare Provider Number

250123

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/2/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/1/2024

Last Recertification Date

Termination Date
Termination Reason

4/1/2025
DSH percentage below statutory minimum

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

3535 Bienville Blvd
220
Ocean Springs, MS 39564

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
AL	HOS0040P	1083893937,1124136593
FL	095912000	1124136593,1083893937
LA	1732524	1083893937,1124136593
MS	000020059,100000111,100008411,100008396	1083893937,1124136593

Shipping Addresses

Same as Street Address

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
DSH250123A	Child	DSH	SINGING RIVER GULFPORT	Singing River Digestive Health - GI	15190 Community Rd	Gulfport	MS	Terminated
DSH250123B	Child	DSH	SINGING RIVER GULFPORT	Singing River - Surgical Services	15190 Community Rd	Gulfport	MS	Terminated
DSH250123C	Child	DSH	SINGING RIVER GULFPORT	SINGING RIVER GULFPORT - Singing River Medical Clinic- Orange Grove	12121 US 49	GULFPORT	MS	Terminated
DSH250123D	Child	DSH	SINGING RIVER GULFPORT	SINGING RIVER GULFPORT - Singing River Medical Clinic- Cowan Rd	350 COWAN RD	GULFPORT	MS	Terminated
DSH250123E	Child	DSH	SINGING RIVER GULFPORT	SINGING RIVER GULFPORT - Singing River Orthopedics	15190 COMMUNITY RD, STE 120	GULFPORT	MS	Terminated
DSH250123F	Child	DSH	SINGING RIVER GULFPORT	SINGING RIVER GULFPORT - Wound Care Services	15190 COMMUNITY RD STE 140	GULFPORT	MS	Terminated
DSH250123G	Child	DSH	SINGING RIVER GULFPORT	Ocean Springs Cancer Center - Oncology	3535 Bienville Blvd	Ocean Springs	MS	Terminated
DSH250123H	Child	DSH	SINGING RIVER GULFPORT	Singing River Pulmonary Services - Pulmonology	3635 Bienville Blvd	Ocean Springs	MS	Terminated
DSH250123J	Child	DSH	SINGING RIVER GULFPORT	Singing River Endocrinology Clinic - Endocrinology	3635 Bienville Blvd	Ocean Springs	MS	Terminated
DSH250123K	Child	DSH	SINGING RIVER GULFPORT	Singing River Cancer Center - Oncology	2809 Denny Avenue	Pascagoula	MS	Terminated
DSH250123L	Child	DSH	SINGING RIVER GULFPORT	The Neuroscience Center - Neurology	3603 Bienville Blvd	Ocean Springs	MS	Terminated
DSH250123M	Child	DSH	SINGING RIVER GULFPORT	Singing River Regional Digestive Specialist - Gastroenterology	4511 Hospital Street	Pascagoula	MS	Terminated
DSH250123N	Child	DSH	SINGING RIVER GULFPORT	Singing River Regional Digestive Specialist - Gastroenterology	1270 Ocean Springs Road	Ocean Springs	MS	Terminated
DSH250123P	Child	DSH	SINGING RIVER GULFPORT	Singing River Rheumatology Clinic OSH - Rheumatology	3603 Bienville Blvd	Ocean Springs	MS	Terminated
DSH250123Q	Child	DSH	SINGING RIVER GULFPORT	Singing River Rheumatology Clinic - Rheumatology	3101 Denny Avenue	Pascagoula	MS	Terminated
DSH250123R	Child	DSH	SINGING RIVER GULFPORT	Singing River Specialty Clinics Rheumatology - Rheumatotlogy	967 Cedar Lake	Biloxi	MS	Terminated
DSH250123S	Child	DSH	SINGING RIVER GULFPORT	Outpatient Clinical Services Pascagoula - Clinical Services	2809 Denny Avenue	Pacagoula	MS	Terminated
DSH250123T	Child	DSH	SINGING RIVER GULFPORT	Outpatient Clinical Services Ocean Springs - Outpatient Clinical Services	3109 Bienville Blvd	Ocean Springs	MS	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		2/28/2025 12:00:00 AM	3/3/2025 6:31 AM
Details	State	Update	Termination Request	Active	To Be Terminated	3/3/2025 6:31 AM
Terminations	Termination Comments	Update	Termination Request		We anticipated receiving our Medicare Cost Report today, however we have been informed the report will not be finalized until mid next week. We have been notified that the cost report will reveal that we no longer meet the DSH percentage required for 340B eligibility. Therefore we are terminating our DSH participation.	3/3/2025 6:31 AM
Terminations	Termination Date	Update	Termination Request		4/1/2025 12:00:00 AM	3/3/2025 6:31 AM
Terminations	Termination Effective Date	Update	Termination Request		3/1/2025 12:00:00 AM	3/3/2025 6:31 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	3/3/2025 6:31 AM
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Thompson, Heath Allen Administrator Ancillary Services Singing River Health System 2288181191	8/1/2024 7:22 AM
Details	340B ID	Update	New Registration		DSH250123G	8/1/2024 7:22 AM
Details	Entity Subname	Update	New Registration	Ocean Springs Cancer Center	Ocean Springs Cancer Center - Oncology	8/1/2024 7:22 AM
Dates	Participating Approval Date	Update	New Registration		8/1/2024 7:22:12 AM	8/1/2024 7:22 AM
Details	State	Update	New Registration	Pending	Approved	8/1/2024 7:22 AM
Dates	Signed By Date	Update	New Registration		7/3/2024 4:50:47 PM	8/1/2024 7:22 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/1/2024 7:22 AM
Addresses	Main Address	Insert	New Registration		3535 Bienville Blvd 220 Ocean Springs, MS 39564	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HOS0040P	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		095912000	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1732524	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000020059	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100000111	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100008411	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100008396	7/2/2024 12:16 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	7/2/2024 12:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	7/2/2024 12:16 PM
Medicaid Billing	NPI: State	Insert	New Registration		AL	7/2/2024 12:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	7/2/2024 12:16 PM
Medicaid Billing	NPI: State	Insert	New Registration		AL	7/2/2024 12:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	7/2/2024 12:16 PM
Medicaid Billing	NPI: State	Insert	New Registration		FL	7/2/2024 12:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	7/2/2024 12:16 PM
Medicaid Billing	NPI: State	Insert	New Registration		FL	7/2/2024 12:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	7/2/2024 12:16 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	7/2/2024 12:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	7/2/2024 12:16 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	7/2/2024 12:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	7/2/2024 12:16 PM
Medicaid Billing	NPI: State	Insert	New Registration		MS	7/2/2024 12:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	7/2/2024 12:16 PM
Medicaid Billing	NPI: State	Insert	New Registration		MS	7/2/2024 12:16 PM
Contacts	Authorizing Official	Insert	New Registration		Thompson, Heath Allen Administrator Ancillary Services Singing River Health System 2288181191	7/2/2024 12:16 PM
Contacts	Primary Contact	Insert	New Registration		Fratesi, Lisa D Executive Director of Pharmacy Singing River Health System 6623470066	7/2/2024 12:16 PM
Details	Assistance Received From Date	Insert	New Registration			7/2/2024 12:16 PM
Details	Assistance Received To Date	Insert	New Registration			7/2/2024 12:16 PM
Details	Last Recertification Date	Insert	New Registration			7/2/2024 12:16 PM
Details	Grant Number	Insert	New Registration			7/2/2024 12:16 PM
Details	340B ID	Insert	New Registration			7/2/2024 12:16 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/2/2024 12:16 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/2/2024 12:16 PM
Details	Medicare Provider Number	Insert	New Registration		250123	7/2/2024 12:16 PM
Details	Entity Name	Insert	New Registration		SINGING RIVER GULFPORT	7/2/2024 12:16 PM
Details	NOFO Number	Insert	New Registration			7/2/2024 12:16 PM
Details	Program Code	Insert	New Registration		DSH	7/2/2024 12:16 PM
Details	Entity Subname	Insert	New Registration		Ocean Springs Cancer Center	7/2/2024 12:16 PM
Dates	Participating Approval Date	Insert	New Registration			7/2/2024 12:16 PM
Details	State	Insert	New Registration		Pending	7/2/2024 12:16 PM
Dates	Registration Date	Insert	New Registration		7/2/2024 12:16:43 PM	7/2/2024 12:16 PM
Dates	Signed By Date	Insert	New Registration			7/2/2024 12:16 PM
Dates	Start Date	Insert	New Registration			7/2/2024 12:16 PM
Terminations	Termination Comments	Insert	New Registration			7/2/2024 12:16 PM
Terminations	Termination Date	Insert	New Registration			7/2/2024 12:16 PM
Terminations	Termination Effective Date	Insert	New Registration			7/2/2024 12:16 PM
Terminations	Termination Reason	Insert	New Registration			7/2/2024 12:16 PM