Covered Entity Details

RRC250040-47 SINGING RIVER HEALTH SYSTEM (Approved) - information as of 4/25/2025 6:36:11 PM

Main Details

Name

SINGING RIVER HEALTH SYSTEM

Subdivision Name

Singing River Gulfport Ortthopedic Clinic - Orthopedics

Type

Rural Referral Center

Rural

Yes

340B ID

RRC250040-47

Medicare Provider Number

250040

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/10/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/16/2025

Last Recertification Date

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

15190 Community Road
Suite 120
Gulfport, MS 39503-3494

Billing Address

Singing River Health System
2809 Denny Avenue
Pascagoula, MS 39581

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	1124136593,1083893937
FL	095912000	1124136593,1083893937
LA	1732524	1124136593,1083893937
MS	000020059,100008396,004672562	1124136593,1083893937

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
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
Contacts	Signed By	Insert	New Registration		Thompson, Heath Allen Administrator Ancillary Services Singing River Health System 2288181191	4/16/2025 2:32 PM
Details	340B ID	Update	New Registration		RRC250040-47	4/16/2025 2:32 PM
Details	Entity Subname	Update	New Registration	Singing River Gulfport Ortthopedic Clinic	Singing River Gulfport Ortthopedic Clinic - Orthopedics	4/16/2025 2:32 PM
Dates	Participating Approval Date	Update	New Registration		4/16/2025 2:32:22 PM	4/16/2025 2:32 PM
Details	State	Update	New Registration	Pending	Approved	4/16/2025 2:32 PM
Dates	Signed By Date	Update	New Registration		4/15/2025 6:37:52 PM	4/16/2025 2:32 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/16/2025 2:32 PM
Addresses	Main Address	Insert	New Registration		15190 Community Road Suite 120 Gulfport, MS 39503-3494	4/10/2025 8:25 PM
Addresses	Billing Address	Insert	New Registration		Singing River Health System 2809 Denny Avenue Pascagoula, MS 39581	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HOS0040P	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		095912000	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1732524	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000020059	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100008396	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		004672562	4/10/2025 8:25 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	4/10/2025 8:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	4/10/2025 8:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		AL	4/10/2025 8:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	4/10/2025 8:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		AL	4/10/2025 8:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	4/10/2025 8:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		FL	4/10/2025 8:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	4/10/2025 8:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		FL	4/10/2025 8:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	4/10/2025 8:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	4/10/2025 8:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	4/10/2025 8:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	4/10/2025 8:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124136593	4/10/2025 8:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		MS	4/10/2025 8:25 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1083893937	4/10/2025 8:25 PM
Medicaid Billing	NPI: State	Insert	New Registration		MS	4/10/2025 8:25 PM
Contacts	Authorizing Official	Insert	New Registration		Thompson, Heath Allen Administrator Ancillary Services Singing River Health System 2288181191	4/10/2025 8:25 PM
Contacts	Primary Contact	Insert	New Registration		Fratesi, Lisa D Executive Director of Pharmacy Singing River Health System 6623470066	4/10/2025 8:25 PM
Details	Assistance Received From Date	Insert	New Registration			4/10/2025 8:25 PM
Details	Assistance Received To Date	Insert	New Registration			4/10/2025 8:25 PM
Details	Last Recertification Date	Insert	New Registration			4/10/2025 8:25 PM
Details	Grant Number	Insert	New Registration			4/10/2025 8:25 PM
Details	340B ID	Insert	New Registration			4/10/2025 8:25 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/10/2025 8:25 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/10/2025 8:25 PM
Details	Medicare Provider Number	Insert	New Registration		250040	4/10/2025 8:25 PM
Details	Entity Name	Insert	New Registration		SINGING RIVER HEALTH SYSTEM	4/10/2025 8:25 PM
Details	NOFO Number	Insert	New Registration			4/10/2025 8:25 PM
Details	Program Code	Insert	New Registration		RRC	4/10/2025 8:25 PM
Details	Entity Subname	Insert	New Registration		Singing River Gulfport Ortthopedic Clinic	4/10/2025 8:25 PM
Dates	Participating Approval Date	Insert	New Registration			4/10/2025 8:25 PM
Details	State	Insert	New Registration		Pending	4/10/2025 8:25 PM
Dates	Registration Date	Insert	New Registration		4/10/2025 8:25:27 PM	4/10/2025 8:25 PM
Dates	Signed By Date	Insert	New Registration			4/10/2025 8:25 PM
Dates	Start Date	Insert	New Registration			4/10/2025 8:25 PM
Terminations	Termination Comments	Insert	New Registration			4/10/2025 8:25 PM
Terminations	Termination Date	Insert	New Registration			4/10/2025 8:25 PM
Terminations	Termination Effective Date	Insert	New Registration			4/10/2025 8:25 PM
Terminations	Termination Reason	Insert	New Registration			4/10/2025 8:25 PM