Covered Entity Details

DSH250019KE MEMORIAL HOSPITAL AT GULFPORT (Approved) - information as of 4/25/2025 5:41:27 PM

Main Details

Name

MEMORIAL HOSPITAL AT GULFPORT

Subdivision Name

Memorial Physician Clinics Three River Multispecialty - Cardiology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH250019KE

Medicare Provider Number

250019

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/4/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/7/2025

Last Recertification Date

Contacts

Authorizing Official

Memorial Hospital at Gulfport
Kent Nicaud, President and Chief Executive Officer
(228) 867-4046

Primary Contact

Memorial Hospital at Gulfport
Brian Clark, Outpatient Pharmacy Director
(228) 867-4485

Addresses

Street Address

9424 Three Rivers Road, Suite B
Gulfport, MS 39503

Billing Address

Memorial Hospital at Gulfport
4500 13th Street
Gulfport, MS 39501

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	000020027,002857850	1073606901,1093142598

Shipping Addresses

Shipping Address 1

Memorial Hospital at Gulfport
4500 13th Street
Gulfport, MS 39501

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
DSH250019A	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Neurosurgery	1340 Broad Avenue MOB Suite 440	Gulfport	MS	Active
DSH250019AA	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Retail: The Clinic at Walmart	9350-A Highway 49 North	Gulfport	MS	Active
DSH250019AB	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Orange Grove Medical Specialties- Family Practice	15286 Community Road	Gulfport	MS	Active
DSH250019AC	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Orthopaedic Trauma Surgeons	1397 Broad Avenue	Gulfport	MS	Active
DSH250019AD	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Orthopaedic Surgeons	2781 C.T. Switzer Dr. Suite 402	Biloxi	MS	Active
DSH250019AE	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Pass Road Internal Medicine Clinic	2771 Pass Road	Biloxi	MS	Active
DSH250019AF	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial South Coast Internist	1340 Broad Avenue MOB Suite 310	Gulfport	MS	Active
DSH250019AH	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Southern Coast Family Medicine	394 Courthouse Road, Suite A	Gulfport	MS	Active
DSH250019AJ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cyber Knife	1340 Broad Avenue MOB Suite 160	Gulfport	MS	Active
DSH250019AK	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Cardiothoracic Surgery Clinic	1340 Broad Avenue, MOB Suite 320	Gulfport	MS	Active
DSH250019AL	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial General Surgeons	1340 Broad Avenue MOB Suite 240	Gulfport	MS	Active
DSH250019AM	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Breast Disease Clinic	1312 44th Avenue	Gulfport	MS	Terminated
DSH250019AN	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Vascular Surgery Consultants	1340 Broad Avenue MOB Suite 220	Gulfport	MS	Active
DSH250019AP	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Pain Management	1340 Broad Avenue MOB Suite 450	Gulfport	MS	Active
DSH250019AQ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Internal Medicine - Bay St. Louis	835 Thames Avenue	Bay St. Louis	MS	Active
DSH250019AR	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Rheumatology Clinic	1110 Broad Ave	Gulfport	MS	Active
DSH250019AS	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Radiation Oncology Services	1340 Broad Avenue MOB Suite 140	Gulfport	MS	Active
DSH250019AT	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Orthopaedic Surgeons	4603 Hospital Road	Pascagoula	MS	Active
DSH250019AU	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial South Mississippi Nephrology	4300B West Railroad Street	Gulfport	MS	Terminated
DSH250019AV	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial South Mississippi Nephrology - Biloxi	784 Vieux Marche	Biloxi	MS	Terminated
DSH250019AW	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Primary Care at Cedar Lake	1756 Popps Ferry Rd	Biloxi	MS	Active
DSH250019AX	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Pediatrics at Cedar Lake	920 Tommy Munro Drive Suite 202	Biloxi	MS	Terminated
DSH250019AY	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial South Mississippi Nephrology	4300 Leisure Time Drive	Diamondhead	MS	Terminated
DSH250019AZ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Medical Oncology at Cedar lake	920 Tommy Munro Drive, Suite 100	Biloxi	MS	Active
DSH250019B	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Allergy and Immunology Clinic	12261 Hwy 49 North, Suite 11	Gulfport	MS	Active
DSH250019BA	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Drinkwater Multispecialty- Internal Medicine	179 Drinkwater Drive	Bay St Louis	MS	Active
DSH250019BB	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Internal Medicine- Drinkwater- Family Practice	300 Drinkwater Drive	Bay St Louis	MS	Terminated
DSH250019BC	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Courthouse Road- Walk-In Clinic	371 Courthouse Road	Gulfport	MS	Active
DSH250019BD	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Acadian-Neurology	12261 Hwy 49 N	Gulfport	MS	Active
DSH250019BE	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake-Pain Management	1756 Popps Ferry Rd	Biloxi	MS	Terminated
DSH250019BF	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake-Endocrinology	1756 Popps Ferry Rd	Biloxi	MS	Terminated
DSH250019BG	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake-Gastroenterology	1756 Popps Ferry Rd	Biloxi	MS	Terminated
DSH250019BH	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Primary Care at Cedar Lake- Family Practice	1756 Popps Ferry Rd	Biloxi	MS	Active
DSH250019BJ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake-Urology	1756 Popps Ferry Rd	Biloxi	MS	Terminated
DSH250019BK	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake-Orthopedics	1756 Popps Ferry Rd	Biloxi	MS	Terminated
DSH250019BL	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake-Neurosurgery	1756 Popps Ferry Rd	Biloxi	MS	Active
DSH250019BM	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake-Neurology	1756 Popps Ferry Rd	Biloxi	MS	Active
DSH250019BN	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead Clinic-Neurosurgery	45000 E. ALOHA DRIVE, SUITE A	Diamondhead	MS	Terminated
DSH250019BP	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead Clinic-General Surgery	4300 Leisure Time Drive	Diamondhead	MS	Terminated
DSH250019BQ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead Clinic-Urology	4300 Leisure Time Drive	Diamondhead	MS	Approved
DSH250019BR	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead Clinic-Orthopedics	4300 Leisure Time Drive	Diamondhead	MS	Terminated
DSH250019BS	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead Clinic-Neurology	45000 E. ALOHA DRIVE, SUITE A	Diamondhead	MS	Active
DSH250019BT	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Drinkwater, Bay St Louis-Gastroenterology	300 Drinkwater	Bay St Louis	MS	Terminated
DSH250019BU	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT-Neurology	Dinkwater, Bay St Louis-Neurology	300 Drinkwater	Bay St Louis	MS	Terminated
DSH250019BV	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Thames Ave, Bay St Louis-Orthopedic	835 Thames Ave	Bay St Louis	MS	Terminated
DSH250019BW	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Thames Ave, Bay St Louis-Neurology	835 Thames Ave	Bay St Louis	MS	Terminated
DSH250019BX	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Thames Ave, Bay St Louis-Gastroenterology	835 Thames Ave	Bay St Louis	MS	Terminated
DSH250019BY	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Thames Ave, Bay St Louis-Urology	835 Thames Ave	Bay St Louis	MS	Terminated
DSH250019C	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Beatline Medical Clinic	5120 Beatline Road, Suite A	Long Beach	MS	Active
DSH250019CA	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead Clinic-Gastroenterology	45000 EAST ALOHA DRIVE, SUITE A	Diamondhead	MS	Approved
DSH250019CB	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Diagnostic Center- Acadian Plaza	12261 Highway 49 North, Suite 12	Gulfport	MS	Active
DSH250019CC	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Diagnostic Center- Diamondhead	45000 E. ALOHA DRIVE, SUITE A	Diamondhead	MS	Active
DSH250019CD	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Diagnostic Center- Biloxi	1756 Popps Ferry Road, Suite A	Biloxi	MS	Active
DSH250019CE	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Bay St Louis General Surgery and Multispecialty/ General Surgeons	833 Hwy 90 Suite 1	Bay St Louis	MS	Active
DSH250019CF	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice- St. Martin	14213 Cook Road East, Building A	Biloxi	MS	Active
DSH250019CG	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice- Walk-In Clinic- Walmart Lane	189 C Walmart Lane	Biloxi	MS	Terminated
DSH250019CH	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice- Walk-In at Bridgewater Center	8950 Lorraine Road, Suite B	Gulfport	MS	Terminated
DSH250019CJ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice- Ocean Springs	3434 Bienville Blvd	Ocean Springs	MS	Active
DSH250019CK	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinic Waveland	200 US 90	Waveland	MS	Terminated
DSH250019CL	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Hancock Family Practice	4433 Leisure Time Dr	Diamondhead	MS	Active
DSH250019CM	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Pass Road- Neurology	749 Oakleigh Ave	Gulfport	MS	Active
DSH250019CN	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Occupational Medicine Clinic	1110 Broad Avenue, Suite 500	GULFPORT	MS	Terminated
DSH250019CP	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Behavioral Health- Outpatient Services (MOB)	1340 Broad Avenue	Gulfport	MS	Terminated
DSH250019CQ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Behavioral Health- Outpatient Services	11150 U.S. Highway 49 North	Gulfport	MS	Terminated
DSH250019CR	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics - Ocean Springs/ Neurology	3434 BIENVILLE BLVD	OCEAN SPRINGS	MS	Active
DSH250019CS	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT / Gastroenterology- Ocean Springs	3434 BIENVILLE BLVD	OCEAN SPRINGS	MS	Terminated
DSH250019CT	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Infusion Clinic (Oncology)	1340 Broad Avenue	Gulfport	MS	Active
DSH250019CU	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Pulmonary Clinic- Pulmonary Interventional	1340 BROAD AVE, SUITE 410	GULFPORT	MS	Active
DSH250019CV	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Infectious Disease	1340 Broad Avenue	Gulfport	MS	Active
DSH250019CW	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics-Pascagoula Family Practice	4603 Hospital Road	Pascagoula	MS	Active
DSH250019CX	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Pain Management - St. Martin	14209 Cook Road East	Biloxi	MS	Active
DSH250019CY	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Bay St. Louis / Oncology	835 THAMES AVENUE	BAY ST LOUIS	MS	Active
DSH250019CZ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Urgent Care	1104 Broad Avenue	Gulfport	MS	Active
DSH250019D	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Bruni Pediatric Clinic	9454 Three Rivers Rd Ste A	Gulfport	MS	Active
DSH250019DA	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	George County Multi-Specialty Clinic / Pain Management	919 Winter Street	Lucedale	MS	Terminated
DSH250019DB	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Neuro and Spine	14209 Cook Rd	Biloxi	MS	Terminated
DSH250019DC	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Walk-In Clinic at Pharmacy in the Bay	1140 Hwy 90	Bay St. Louis	MS	Terminated
DSH250019DD	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice- Bridgewater Center	8970 Lorraine Road	Gulfport	MS	Active
DSH250019DE	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice- Escatawpa	8006 Highway 613	Moss Point	MS	Active
DSH250019DF	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Internal Medicine- Bay St. Louis - Endocrinology	835 THAMES AVENUE	BAY ST LOUIS	MS	Active
DSH250019DG	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Beatline- Neurology	5120 BEATLINE ROAD	LONG BEACH	MS	Terminated
DSH250019DH	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead- Endocrinology	45000 E. ALOHA DRIVE, SUITE A	DIAMONDHEAD	MS	Active
DSH250019DJ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead- Oncology	45000 E. ALOHA DRIVE, SUITE A	DIAMONDHEAD	MS	Active
DSH250019DK	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Pascagoula Multispecialty Clinic - Neurosurgery	4603 Hospital Road	Pascagoula	MS	Terminated
DSH250019DL	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Gautier Clinic / Pain Management	726 Highway 90, Suite E	Gautier	MS	Terminated
DSH250019DM	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT / Ocean Springs- Neurosurgery	3434 BIENVILLE BLVD	OCEAN SPRINGS	MS	Terminated
DSH250019DN	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice Ocean Springs- Endocrinology	3434 BIENVILLE BLVD	OCEAN SPRINGS	MS	Terminated
DSH250019DP	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT / Acadian- Gastroenterology	12261 HWY 49 NORTH	GULFPORT	MS	Terminated
DSH250019DQ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Coast Heart Institute	4215 15th Street	Gulfport	MS	Active
DSH250019DR	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Coast Cardiovascular Associates	1391 BROAD AVENUE	GULFPORT	MS	Active
DSH250019DS	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead- Pain Management	45000 E. ALOHA DRIVE, SUITE A	DIAMONDHEAD	MS	Active
DSH250019DT	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Acadian Plaza- Oncology	12261 Hwy 49 North Ste 11	Gulfport	MS	Terminated
DSH250019DU	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Ocean Springs Primary Care and Multispecialty- Oncology	1501 Bienville Boulevard	OCEAN SPRINGS	MS	Active
DSH250019DV	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics- Heart Rhythm Clinic	1408 44th Avenue	Gulfport	MS	Active
DSH250019DW	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake Surgical Specialties- Neurosurgery	920 Tommy Munro Drive Suite 200	Biloxi	MS	Terminated
DSH250019DX	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Surgical Specialties - Cedar Lake/ General Surgery	920 Tommy Munro Drive, Suite 200	Biloxi	MS	Terminated
DSH250019DY	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Medical Oncology - Drinkwater	300 DRINKWATER Drive	BAY ST LOUIS	MS	Terminated
DSH250019DZ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics St Martin- Urology	14213 Cook Road East, Building A	Biloxi	MS	Active
DSH250019E	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Children's Clinic	20091 Pineville Rd	Long Beach	MS	Active
DSH250019EA	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics-The Crossings at Vidalia	27368 J.P. Ladner Road, Suite 3	Pass Christian	MS	Active
DSH250019EB	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Internal Medicine-West Biloxi	2781 C.T. Switzer Drive, Suite 305	Biloxi	MS	Terminated
DSH250019EC	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake- Endocrinology	920 Tommy Munro Drive, Suite 200	Biloxi	MS	Terminated
DSH250019ED	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Cedar Lake Multispecialty- Pain Management	1756 Popps Ferry Road, Suite A	Biloxi	MS	Active
DSH250019EE	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Cedar Lake Multispecialty- Infectious Disease	1756 Popps Ferry Road, Suite A	Biloxi	MS	Active
DSH250019EF	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Diagnostic Imaging Center- Gulfport	4320 B 15th Street	Gulfport	MS	Terminated
DSH250019EG	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Orange Grove Medical Specialties- Internal Medicine	15286 Community Road	Gulfport	MS	Active
DSH250019EH	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice at Medical Park	1759 Medical Park Drive	Biloxi	MS	Active
DSH250019EJ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Medical Oncology at Merit - Oncology	147 Reynoir Street Suite 204	Biloxi	MS	Terminated
DSH250019EK	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Digestive Health Biloxi - Gastroenterology	147 Reynoir Street Suite 301	Biloxi	MS	Terminated
DSH250019EL	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake - Vascular Surgery	1756 Popps Ferry Road	Biloxi	MS	Terminated
DSH250019EM	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead - Vascular Surgery	4300 LEISURE TIME DRIVE	DIAMONDHEAD	MS	Terminated
DSH250019EN	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Digestive Health- Multi Specialty - Gastroenterology	90 Industrial Park Circle	Ocean Springs	MS	Terminated
DSH250019EP	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Surgery Center- Ocean Springs	3882 Bienville Boulevard	Ocean Springs	MS	Active
DSH250019EQ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Digestive Health Pascagoula - Gastroenterology	3616 Hospital Road	Pascagoula	MS	Terminated
DSH250019ER	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Digestive Health - Gulfport	9424 Three Rivers Road, Suite A	Gulfport	MS	Terminated
DSH250019ES	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Digestive Health Ocean Springs - Gastroenterology	3890 Bienville Boulevard	Ocean Springs	MS	Active
DSH250019ET	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Bay St. Louis General Surgery and Multispecialty - Neurology	833 HWY 90	BAY ST LOUIS	MS	Terminated
DSH250019EU	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Cedar Lake - Cardiology	1756 Popps Ferry Road, Suite A	Biloxi	MS	Active
DSH250019EV	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice- St. Martin - Endocrinology	14213 Cook Road, Building A	Biloxi	MS	Terminated
DSH250019EW	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diamondhead - Cardiology	45000 E. ALOHA DRIVE, SUITE A	DIAMONDHEAD	MS	Active
DSH250019EX	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Digestive Health- Multi Specialty - Orthopedic Surgeons	90 Industrial Park Circle	Ocean Springs	MS	Terminated
DSH250019EY	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Internal Medicine Clinic- Drinkwater - Cardiology	300 Drinkwater Drive	Bay St. Louis	MS	Terminated
DSH250019EZ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice- Escatawpa - Neurology	8006 Highway 613	Moss Point	MS	Terminated
DSH250019F	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Coast Urology Center	1340 Broad Avenue MOB Suite 210	Gulfport	MS	Active
DSH250019FA	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Bay St. Louis General Surgery and Multispecialty - Neurosurgery	833 HIGHWAY 90	BAY ST LOUIS	MS	Terminated
DSH250019FB	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Acadian Plaza - Cardiology	12261 HIGHWAY 49 N	GULFPORT	MS	Active
DSH250019FC	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Internal Medicine Bay St. Louis - Cardiology	835 THAMES AVE	BAY ST LOUIS	MS	Active
DSH250019FD	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Orange Grove Medical Specialties - Cardiology	15286 Community Road	Gulfport	MS	Active
DSH250019FE	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	The Medical Oncology Group (TMOG)	1340 BROAD AVE	GULFPORT	MS	Active
DSH250019FF	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics at Tradition - Family Practice	19289-A Saint Joseph Street	Biloxi	MS	Terminated
DSH250019FG	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics- Pascagoula - Internal Medicine	4603 Hospital Road	Pascagoula	MS	Active
DSH250019FH	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Ocean Springs Primary Care - Family Practice	1501 Bienville Blvd	Ocean Springs	MS	Active
DSH250019FJ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial St. Martin Multi-Specialty - Neurology	14213 Cook Road, Building A	Biloxi	MS	Terminated
DSH250019FK	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Acadian Plaza- Endocrinology	12261 HIGHWAY 49	GULFPORT	MS	Terminated
DSH250019FL	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Nephrology	4300 LEISURE TIME DR	DIAMONDHEAD	MS	Terminated
DSH250019FM	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Nephrology	4300 W RAILROAD ST	GULFPORT	MS	Terminated
DSH250019FN	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Pascagoula Multispecialty Clinic - Neurology	4603 Hospital Road	Pascagoula	MS	Active
DSH250019FP	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Diagnostic Imaging MOB Suite 150 - Radiology	1340 Broad Avenue, MOB Suite 150	Gulfport	MS	Active
DSH250019FQ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Multispecialty at Tradition- Endocrinology - Endocrinology	19289-A Saint Joseph Street	Biloxi	MS	Terminated
DSH250019FR	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Coast Cardiology Center - Cardiology	1203 Broad Ave	Gulfport	MS	Active
DSH250019FS	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Surgical Center Cedar Lake - Surgical Center	1720 B Medical Park Drive	Biloxi	MS	Active
DSH250019FT	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Digestive Health- Multi Specialty- Urology - Urology	90 Industrial Park Circle	Ocean Springs	MS	Terminated
DSH250019FU	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Transitional Care Clinic - Internal Medicine	1404 44th Avenue	Gulfport	MS	Terminated
DSH250019FV	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Gulfport Surgery Clinic - General Surgery	1312 44TH AVE	GULFPORT	MS	Active
DSH250019FW	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Gastroenterology Center - Gastroenterology	4500 W. Railroad Street	Gulfport	MS	Active
DSH250019FX	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Behavioral Health	1110 Broad Avenue, Suite 700	Gulfport	MS	Terminated
DSH250019FY	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Gulf Coast Heart - Cardiology	4533 13th Street	Gulfport	MS	Active
DSH250019FZ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Bridgewater Multispecialty- Neurology	8970 Lorraine Road	Gulfport	MS	Terminated
DSH250019G	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Coast Urology Center	15286 Community Road	Gulfport	MS	Active
DSH250019GA	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Digestive Health- Multi Specialty- General Surgery - General Surgery	90 Industrial Park Circle	Ocean Springs	MS	Terminated
DSH250019GB	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Stone County Medical Center- Family Practice	1440 East Central Avenue	Wiggins	MS	Active
DSH250019GC	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Neurology	147 REYNOIR ST, STE 205	BILOXI	MS	Terminated
DSH250019GD	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL STONE COUNTY MEDICAL CENTE - General Surgery	1440 CENTRAL AVE E	WIGGINS	MS	Terminated
DSH250019GE	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Hospital at Stone County Non-Invasive Cardiology - Non-Invasive Cardiology	1434 East Central Avenue	Wiggins	MS	Active
DSH250019GF	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL STONE COUNTY- Comprehensive Wound Healing	1434 EAST CENTRAL AVE	WIGGINS	MS	Active
DSH250019GG	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Hospital at Stone County Magnetic Resonance Imaging	1434 East Central Avenue	Wiggins	MS	Active
DSH250019GH	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Hospital at Stone County Emergency Department - Emergency Department	1434 East Central Avenue	Wiggins	MS	Active
DSH250019GJ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Hospital at Stone County Computed Tomography - Computed Tomography	1434 East Central Avenue	Wiggins	MS	Active
DSH250019GK	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Gautier Walk-In	6510 HIGHWAY 90, Suite A	GAUTIER	MS	Active
DSH250019GL	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - ENT	1201 31ST AVE	GULFPORT	MS	Active
DSH250019GM	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL STONE COUNTY MEDICAL CENTE - Neurology	1440 E. CENTRAL AVE	WIGGINS	MS	Active
DSH250019GN	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Gulf South Surgery Center	1206 31ST AVE	GULFPORT	MS	Active
DSH250019GP	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Occupational Medicine	1759 MEDICAL PARK DR	BILOXI	MS	Active
DSH250019GQ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL STONE COUNTY MEDICAL CENTE - Endocrinology	1440 E. CENTRAL AVE	WIGGINS	MS	Active
DSH250019GR	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Gaddy Vision	10051 LORRAINE RD	GULFPORT	MS	Terminated
DSH250019GS	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics George County Multispecialty- Orthopedic Surgery	57 Ratliff Street	LUCEDALE	MS	Active
DSH250019GT	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Physician Clinics Broad Avenue Family Practice	1202 BROAD AVE	GULFPORT	MS	Active
DSH250019GU	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics - Crittenden Internal Medicine	1001 Benigno Lane	Bay St. Louis	MS	Active
DSH250019GV	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Hospital at Stone County - Vascular Main	1434 East Central Avenue	Wiggins	MS	Active
DSH250019GW	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Merit Multispecialty - Cardiology	147 Reynoir Street, Suite 204	Biloxi	MS	Active
DSH250019GX	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Multispecialty at Three Rivers - Endocrinology	9454 Three Rivers Road, Suite D	Gulfport	MS	Active
DSH250019GY	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Specialty Clinic Acadian Plaza - Orthopedic Surgery	12261 Highway 49 N., Suite 11	Gulfport	MS	Terminated
DSH250019GZ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Hospital at Stone County - Nuclear Medicine	1434 East Central Avenue	Wiggins	MS	Terminated
DSH250019H	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Diamondhead Family Medicine	45000 E. ALOHA DRIVE, SUITE A	Diamondhead	MS	Active
DSH250019HA	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Broad Avenue - Orthopedics	1397 Broad Avenue	Gulfport	MS	Active
DSH250019HB	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Woman's Clinic Gulfport - Obstetrics	4577 Thirteenth Street	Gulfport	MS	Active
DSH250019HC	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Woman's Clinic Biloxi - Obstetrics	2781 C.T. Switzer Sr. Drive, Suite 306	Biloxi	MS	Active
DSH250019HD	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Hospital at Stone County - Infusion Clinic	1434 East Central Avenue	Wiggins	MS	Active
DSH250019HE	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Stone County Multi Specialty - Cardiology	1440 East Central Avenue	Wiggins	MS	Active
DSH250019HF	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Primary Care Wiggins - Family Practice	1428 South Azalea Drive	Wiggins	MS	Active
DSH250019HG	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Cowan Multispecialty - Plastic Surgery	1107 Cowan Road	Gulfport	MS	Terminated
DSH250019HH	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Digestive Health- Multi Specialty- Cardiology	90 INDUSTRIAL PARK CIR	OCEAN SPRINGS	MS	Terminated
DSH250019HJ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Stone County Multi Specialty - Oncology	1440 East Central Avenue	Wiggins	MS	Active
DSH250019HK	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Multispecialty at Merit - Neurology	147 Reynoir Street, Suite 204	Biloxi	MS	Active
DSH250019HL	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics - Physical Medicine and Rehab	1397 Broad Avenue	Gulfport	MS	Active
DSH250019HM	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Tommy Munro Family Practice - Family Practice	971 Tommy Munro Drive, Suite C	Biloxi	MS	Terminated
DSH250019HN	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Lakeview Family Medicine - Family Medicine	3680 Sangani Blvd, Suite H2	Diberville	MS	Terminated
DSH250019HP	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Pass Christian Family Medicine - Family Medicine	116 Menge Avenue, Suite B	Pass Christian	MS	Active
DSH250019HQ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Memorial Merit Multispecialty - Podiatry	147 Reynoir Street, Suite 204	Biloxi	MS	Active
DSH250019HR	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics 44th Avenue Internal Medicine - Internal Medicine	1404 44th Avenue	Gulfport	MS	Active
DSH250019HS	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Cedar Lake Multispecialty - Gastroenterology	1756 Popps Ferry Road, Suite A	Biloxi	MS	Active
DSH250019HT	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Pascagoula Multispecialty - Gastroenterology	4603 Hospital Road	Pascagoula	MS	Active
DSH250019HU	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Gulf Coast Sleep and Pulmonary - Pulmonary	15286 Community Road, Suite B	Gulfport	MS	Terminated
DSH250019HV	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Pass Christian- Endocrinology	118 Menge Avenue	Pass Christian	MS	Active
DSH250019HW	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Lakeview Multispecialty - Neurology	3680 Sangani Blvd, Suite H2	D'Iberville	MS	Terminated
DSH250019HX	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Primary Care and Multispecialty Wiggins - General Surgery	1428 South Azalea Drive	Wiggins	MS	Active
DSH250019HY	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Bay St. Louis General Surgery and Multispecialty - Orthopedic Surgery	833 Highway 90, Suite 1	Bay St. Louis	MS	Terminated
DSH250019HZ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Hancock Multispecialty - Orthopedic Surgery	4300 Leisure Time Drive	Diamondhead	MS	Active
DSH250019J	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Endocrinology Clinic	4540 W Railroad St	Gulfport	MS	Active
DSH250019JA	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Primary Care and Multispecialty Wiggins - Orthopedics	1428 South Azalea Drive	Wiggins	MS	Active
DSH250019JB	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Stone County Mutispecialty - Women's Health	1440 East Central Avenue	Wiggins	MS	Terminated
DSH250019JC	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Stone County Multispecialty - Podiatry	1440 East Central Avenue	Wiggins	MS	Active
DSH250019JD	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Gulf Coast Gastroenterology - Gastroenterology	14209 Cook Road East, Suite 200	Biloxi	MS	Active
DSH250019JE	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Ocean Springs Primary Care and Multispecialty - Gastroenterology	1501 Bienville Boulevard	Ocean Springs	MS	Active
DSH250019JF	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Gulf Coast ENT - ENT	9000 Lorraine Road	Gulfport	MS	Active
DSH250019JG	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Physician Clinics GME- Courthouse Family Practice	371 COURTHOUSE RD	GULFPORT	MS	Active
DSH250019JH	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Physician Clinics Broad Avenue Multispecialty- Gastroenterology	1110 BROAD AVE	GULFPORT	MS	Active
DSH250019JJ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Physician Clinics Courthouse Multispecialty- Endocrinology	394 COURTHOUSE RD	GULFPORT	MS	Active
DSH250019JK	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Physician Clinics Orange Grove Multispecialty- Neurology	15286 COMMUNITY RD	GULFPORT	MS	Active
DSH250019JL	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Physician Clinics Diamondhead Multispecialty- General Surgery	45000 E ALOHA DR	DIAMONDHEAD	MS	Active
DSH250019JM	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Specialty Clinic Acadian Plaza - General Surgery	12261 Highway 49 North, Suite 11	Gulfport	MS	Active
DSH250019JN	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Physician Clinics Cedar Lake Multispecialty- Women's Health	1756 POPPS FERRY RD	BILOXI	MS	Active
DSH250019JP	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Infusion Clinic- Cedar Lake	920 TOMMY MUNRO DR	BILOXI	MS	Active
DSH250019JQ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Broad Avenue Community Care - Family Practice	1104 Broad Avenue	Gulfport	MS	Active
DSH250019JR	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Family Practice Diamondhead- Occupational Medicine	45000 E ALOHA DR	DIAMONDHEAD	MS	Active
DSH250019JS	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Broad Avenue Community Care - Occupational Medicine	1104 Broad Avenue	Gulfport	MS	Active
DSH250019JT	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Broad Avenue Internal Medicine	1104 Broad Avenue	Gulfport	MS	Active
DSH250019JU	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Pass Christian Multispecialty - Women's Health	118 Menge Avenue	Pass Christian	MS	Active
DSH250019JV	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Stone County Medical Center - Occupational Medicine	1440 East Central Avenue	Wiggins	MS	Active
DSH250019JW	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Infusion Clinic- Diamondhead	45000 E ALOHA DR	DIAMONDHEAD	MS	Active
DSH250019JX	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Pass Road Internal Medicine Clinic- Walk-In	2771 PASS RD	BILOXI	MS	Active
DSH250019JY	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	MEMORIAL HOSPITAL AT GULFPORT - Memorial Specialty Clinic Acadian Plaza- Womens Health	12261 HIGHWAY 49	GULFPORT	MS	Active
DSH250019JZ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Neuro and Spine - Neurolgy	14209 Cook Road East, Suite100	Biloxi	MS	Active
DSH250019K	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice- Acadian Plaza	12261 Hwy 49 N., Suite 11	Gulfport	MS	Active
DSH250019KA	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physicians Clinics Digestive Health Cedar Lake - Gastroenterology	1720A Medical Park Drive, Suite 300	Biloxi	MS	Active
DSH250019KB	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Escatawpa Multispecialty - Pain Management	8006 Highway 613	Moss Point	MS	Approved
DSH250019KC	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Pascagoula Multispecialty - Pain Management	4603 Hospital Road	Pascagoula	MS	Approved
DSH250019KD	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Bay Internal & Multispecialty - Pain Management	952 Green Meadow Road	Bay St. Louis	MS	Approved
DSH250019KE	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Three River Multispecialty - Cardiology	9424 Three Rivers Road, Suite B	Gulfport	MS	Approved
DSH250019KF	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Southern MS Heart Center– Gulfport South - Cardiology	4300 B West Railroad	Gulfport	MS	Approved
DSH250019KG	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Gulf Coast Heart Institute - Cardiology	3111 Shortcut Road	Pascagoula	MS	Approved
DSH250019KH	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Ocean Springs Primary Care and Multispecialty - Cardiology	1501 Bienville Boulevard	Ocean Springs	MS	Approved
DSH250019KJ	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Southern MS Heart Center- Gulfport North - Cardiology	15464 Oak Lane, Suite 100F	Gulfport	MS	Approved
DSH250019KK	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Southern MS Heart Center- Pascagoula - Cardiology	4603 Hospital Road	Pascagoula	MS	Approved
DSH250019KL	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Southern MS Heart Center- Ocean Springs - Cardiology	3704 Bienville Boulevard, Suite B	Ocean Springs	MS	Approved
DSH250019KM	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Bay Internal & Multispecialty - Internal Medicine	952 Green Meadow Road	Bay St. Louis	MS	Approved
DSH250019KN	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Physician Clinics Pass Christian Multispecialty - Neurology	118 Menge Avenue	Pass Christian	MS	Approved
DSH250019KP	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Gulfport OBGYN Clinic - OB-GYN / Womens Health	4502 Old Pass Road	Gulfport	MS	Approved
DSH250019L	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice - Three Rivers	9454 Three Rivers Road Ste D	Gulfport	MS	Active
DSH250019M	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Gastroenterology	1340 Broad Ave MOB Suite 300	Gulfport	MS	Active
DSH250019N	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Gulf Coast Pediatrics - Acadian Court	12259 Hwy 49 Ste C	Gulfport	MS	Terminated
DSH250019P	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Gulf Coast Pediatrics - Bay St. Louis	833 Highway 90	Bay St. Louis	MS	Terminated
DSH250019Q	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Gulf Coast Pediatrics at Bridgewater Center	8950 Lorraine Road	Gulfport	MS	Terminated
DSH250019R	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Gulf Coast Pulmonary Consultants	9424 Three Rivers Road, Suite A	Gulfport	MS	Active
DSH250019S	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Internal Medicine - Acadian Plaza	12261 Highway 49 N., Suite 9 & 11	Gulfport	MS	Active
DSH250019T	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Internal Medicine Clinic	1110 Broad Ave Ste 700	Gulfport	MS	Active
DSH250019U	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Living Waters Community Medical Center	13472 Vidalia Rd	Pass Christian	MS	Terminated
DSH250019V	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Family Practice- Beatline	5120 Beatline Road, Suite B	Long Beach	MS	Active
DSH250019W	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Lyman Family Practice	20006 Hwy 53	Gulfport	MS	Terminated
DSH250019X	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Magnolia Grove Healthcare	4333 15th Street, Suite A	Gulfport	MS	Active
DSH250019Y	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Hematology and Oncology Partners	1340 Broad Avenue MOB Suite 330	Gulfport	MS	Active
DSH250019Z	Child	DSH	MEMORIAL HOSPITAL AT GULFPORT	Memorial Neurosciences	1340 Broad Avenue MOB Suite 440	Gulfport	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Nicaud, Kent President and Chief Executive Officer Memorial Hospital at Gulfport 2288674046	4/7/2025 11:25 AM
Details	340B ID	Update	New Registration		DSH250019KE	4/7/2025 11:25 AM
Details	Entity Subname	Update	New Registration	Memorial Physician Clinics Three River Multispecialty	Memorial Physician Clinics Three River Multispecialty - Cardiology	4/7/2025 11:25 AM
Dates	Participating Approval Date	Update	New Registration		4/7/2025 11:25:16 AM	4/7/2025 11:25 AM
Details	State	Update	New Registration	Pending	Approved	4/7/2025 11:25 AM
Dates	Signed By Date	Update	New Registration		4/4/2025 2:57:23 PM	4/7/2025 11:25 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/7/2025 11:25 AM
Addresses	Main Address	Insert	New Registration		9424 Three Rivers Road, Suite B Gulfport, MS 39503	4/4/2025 10:55 AM
Addresses	Billing Address	Insert	New Registration		Memorial Hospital at Gulfport 4500 13th Street Gulfport, MS 39501	4/4/2025 10:55 AM
Addresses	Shipping Address	Insert	New Registration		Memorial Hospital at Gulfport 4500 13th Street Gulfport, MS 39501	4/4/2025 10:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:55 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000020027	4/4/2025 10:55 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	4/4/2025 10:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:55 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		002857850	4/4/2025 10:55 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	4/4/2025 10:55 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1073606901	4/4/2025 10:55 AM
Medicaid Billing	NPI: State	Insert	New Registration		MS	4/4/2025 10:55 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1093142598	4/4/2025 10:55 AM
Medicaid Billing	NPI: State	Insert	New Registration		MS	4/4/2025 10:55 AM
Contacts	Primary Contact	Insert	New Registration		Clark, Brian Outpatient Pharmacy Director Memorial Hospital at Gulfport 2288674485	4/4/2025 10:55 AM
Contacts	Authorizing Official	Insert	New Registration		Nicaud, Kent President and Chief Executive Officer Memorial Hospital at Gulfport 2288674046	4/4/2025 10:55 AM
Details	Assistance Received From Date	Insert	New Registration			4/4/2025 10:55 AM
Details	Assistance Received To Date	Insert	New Registration			4/4/2025 10:55 AM
Details	Last Recertification Date	Insert	New Registration			4/4/2025 10:55 AM
Details	Grant Number	Insert	New Registration			4/4/2025 10:55 AM
Details	340B ID	Insert	New Registration			4/4/2025 10:55 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/4/2025 10:55 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/4/2025 10:55 AM
Details	Medicare Provider Number	Insert	New Registration		250019	4/4/2025 10:55 AM
Details	Entity Name	Insert	New Registration		MEMORIAL HOSPITAL AT GULFPORT	4/4/2025 10:55 AM
Details	NOFO Number	Insert	New Registration			4/4/2025 10:55 AM
Details	Program Code	Insert	New Registration		DSH	4/4/2025 10:55 AM
Details	Entity Subname	Insert	New Registration		Memorial Physician Clinics Three River Multispecialty	4/4/2025 10:55 AM
Dates	Participating Approval Date	Insert	New Registration			4/4/2025 10:55 AM
Details	State	Insert	New Registration		Pending	4/4/2025 10:55 AM
Dates	Registration Date	Insert	New Registration		4/4/2025 10:55:54 AM	4/4/2025 10:55 AM
Dates	Signed By Date	Insert	New Registration			4/4/2025 10:55 AM
Dates	Start Date	Insert	New Registration			4/4/2025 10:55 AM
Terminations	Termination Comments	Insert	New Registration			4/4/2025 10:55 AM
Terminations	Termination Date	Insert	New Registration			4/4/2025 10:55 AM
Terminations	Termination Effective Date	Insert	New Registration			4/4/2025 10:55 AM
Terminations	Termination Reason	Insert	New Registration			4/4/2025 10:55 AM