Covered Entity Details

DSH250078D FORREST GENERAL HOSPITAL (Active) - information as of 4/25/2025 7:30:19 PM

Main Details

Name

FORREST GENERAL HOSPITAL

Subdivision Name

Orthopedic Institute - Recovery Room

Type

Disproportionate Share Hospital

Rural

340B ID

DSH250078D

Medicare Provider Number

250078

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/3/2014

Participating Start Date

7/1/2014

Participating Approval Date

6/11/2014

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

Forrest General Hospital
Ben Hester, CFO
(601) 288-4225

Primary Contact

Forrest General Hospital
Teresa Rowley McDaniel, Director of Pharmacy
(601) 288-1485

Addresses

Street Address

27 Southern Point Parkway
Hattiesburg, MS 39402

Billing Address

Forrest General Hosptial - Orthopedic Institute
6051 U.S. Highway 49
Hattiesburg, MS 39401-7243

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	00020007	1225041809

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
DSH250078B	Child	DSH	FORREST GENERAL HOSPITAL	Forrest Health Infusion Center	301 SOUTH 28TH AVENUE	HATTIESBURG	MS	Active
DSH250078C	Child	DSH	FORREST GENERAL HOSPITAL	Orthopedic Institute - Operating Room	27 Southern Point Parkway	Hattiesburg	MS	Active
DSH250078D	Child	DSH	FORREST GENERAL HOSPITAL	Orthopedic Institute - Recovery Room	27 Southern Point Parkway	Hattiesburg	MS	Active
DSH250078E	Child	DSH	FORREST GENERAL HOSPITAL	Orthopedic Institute - Anesthesiology	27 Southern Point Parkway	Hattiesburg	MS	Active
DSH250078F	Child	DSH	FORREST GENERAL HOSPITAL	Orthopedic Institute - Radiology-Diagnostic	27 Southern Point Parkway	Hattiesburg	MS	Active
DSH250078G	Child	DSH	FORREST GENERAL HOSPITAL	Orthopedic Institute - Respiratory Therapy	27 Southern Point Parkway	Hattiesburg	MS	Active
DSH250078H	Child	DSH	FORREST GENERAL HOSPITAL	Asbury Hospice House - Hospice Care	304 S. 40th Avenue	Hattiesburg	MS	Active
DSH250078J	Child	DSH	FORREST GENERAL HOSPITAL	The Heart Care Center of Laurel - Cardiology	404 South 13th Avenue	Laurel	MS	Active
DSH250078K	Child	DSH	FORREST GENERAL HOSPITAL	Hospice - Hospice	304 South 40th Avenue	Hattiesburg	MS	Active
DSH250078L	Child	DSH	FORREST GENERAL HOSPITAL	Family Medicine Residency Clinic - Family Medicine	415 South 28th Ave	Hattiesburg	MS	Active
DSH250078M	Child	DSH	FORREST GENERAL HOSPITAL	Home Health Agency - home health	1414 South 28th Avenue	Hattiesburg	MS	Active
DSH250078N	Child	DSH	FORREST GENERAL HOSPITAL	Radiation Oncology - Radiation	301 South 28th Avenue	Hattiesburg	MS	Active
DSH250078P	Child	DSH	FORREST GENERAL HOSPITAL	Pine Grove Intensive Outpatient - Intensive Outpatient	2255 Broadway Drive	Hattiesburg	MS	Active
DSH250078Q	Child	DSH	FORREST GENERAL HOSPITAL	Pine Grove Partial Hospital Program - Partial Hospital Program	2255 Broadway Drive	Hattiesburg	MS	Active
DSH250078R	Child	DSH	FORREST GENERAL HOSPITAL	Neurosurgery Midtown - Neurology	2807 Arlington Loop	Hattiesburg	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/6/2023 11:01:48 AM	9/4/2024 11:13:27 AM	9/4/2024 11:13 AM
Details	Last Recertification Date	Update	Recertification	9/2/2022 11:54:33 AM	9/6/2023 11:01:48 AM	9/6/2023 11:01 AM
Details	Last Recertification Date	Update	Recertification	8/26/2021 8:50:23 AM	9/2/2022 11:54:33 AM	9/2/2022 11:54 AM
Contacts	Primary Contact	Update	New Registration	McDaniel, Teresa Director of Pharmacy Forrest General Hospital 6012881485	McDaniel, Teresa Rowley Director of Pharmacy Forrest General Hospital 6012881485	4/12/2022 3:38 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 8:49:10 AM	8/26/2021 8:50:23 AM	8/26/2021 8:50 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1225041809	8/18/2020 8:49 AM
Medicaid Billing	NPI: State	Insert	Recertification		MS	8/18/2020 8:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1225041809 ( )		8/18/2020 8:49 AM
Details	Last Recertification Date	Update	Recertification	8/21/2019 8:29:35 AM	8/18/2020 8:49:10 AM	8/18/2020 8:49 AM
Details	Last Recertification Date	Update	Recertification	8/27/2018 4:12:32 PM	8/21/2019 8:29:35 AM	8/21/2019 8:29 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1225041809	10/7/2018 9:10 PM
Details	Last Recertification Date	Update	Recertification	11/9/2017 3:38:41 PM	8/27/2018 4:12:32 PM	8/27/2018 4:12 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/9/2017 3:38:41 PM	11/9/2017 3:38 PM
Contacts	Primary Contact	Update	Profile Change Request	McDaniel, Teresa Director of Pharmacy Forrest General Hospital 6012884185-1485	McDaniel, Teresa Director of Pharmacy Forrest General Hospital 6012881485	10/24/2017 12:11 PM
Contacts	Authorizing Official	Insert	Change Request		Hester, Ben CFO Forrest General Hospital 6012884225	10/12/2017 7:32 AM
Contacts	Signed By	Update	Change Request	Woodard, Andy Chief Financial Officer 6012882892	Woodard, Andy Chief Financial Officer Highland Community Hospital 6012882892	10/5/2017 2:50 PM
Contacts	Primary Contact	Update		McDaniel, Teresa Director of Pharmacy 6012884185	McDaniel, Teresa Director of Pharmacy Forrest General Hospital 6012884185-1485	9/18/2017 4:22 PM
Contacts	Signed By	Insert			Woodard, Andy Chief Financial Officer 6012882892	8/14/2017 11:50 AM
Contacts	Primary Contact	Insert			McDaniel, Teresa Director of Pharmacy 6012884185	8/14/2017 11:50 AM
Addresses	Main Address	Insert			27 Southern Point Parkway Hattiesburg, MS 39402	8/14/2017 11:50 AM
Addresses	Billing Address	Insert			Forrest General Hosptial - Orthopedic Institute 6051 U.S. Highway 49 Hattiesburg, MS 39401-7243	8/14/2017 11:50 AM
Medicaid Billing	Medicaid: Number	Update		250078	00020007	8/14/2017 11:49 AM
Details	Last Recertification Date	Update		8/7/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 12:07 PM
Details	Last Recertification Date	Update		8/11/2014 12:00:00 AM	8/7/2015 12:00:00 AM	8/7/2015 2:50 PM
Details	Last Recertification Date	Update			8/11/2014 12:00:00 AM	8/11/2014 12:54 PM
Dates	Participating Approval Date	Update			6/11/2014 12:00:00 AM	6/11/2014 4:55 PM
Details	State	Update		Pending	Active	6/11/2014 4:55 PM
Dates	Start Date	Update			7/1/2014 12:00:00 AM	6/11/2014 4:55 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH250078D	4/8/2014 8:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/3/2014 6:43 PM
Medicaid Billing	Medicaid: Number	Insert			250078	4/3/2014 6:43 PM
Medicaid Billing	Medicaid: State	Insert			MS	4/3/2014 6:43 PM
Details	Last Recertification Date	Insert				4/3/2014 6:43 PM
Details	Grant Number	Insert				4/3/2014 6:43 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	4/3/2014 6:43 PM
Details	Is Authorizing Official EHB Data	Insert				4/3/2014 6:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/3/2014 6:43 PM
Details	Medicare Provider Number	Insert			250078	4/3/2014 6:43 PM
Details	Entity Name	Insert			FORREST GENERAL HOSPITAL	4/3/2014 6:43 PM
Details	Program Code	Insert			DSH	4/3/2014 6:43 PM
Details	Entity Subname	Insert			Orthopedic Institute - Recovery Room	4/3/2014 6:43 PM
Dates	Participating Approval Date	Insert				4/3/2014 6:43 PM
Details	State	Insert			Pending	4/3/2014 6:43 PM
Dates	Registration Date	Insert			4/3/2014 12:00:00 AM	4/3/2014 6:43 PM
Dates	Signed By Date	Insert			4/3/2014 12:00:00 AM	4/3/2014 6:43 PM
Dates	Start Date	Insert				4/3/2014 6:43 PM
Terminations	Termination Comments	Insert				4/3/2014 6:43 PM
Terminations	Termination Date	Insert				4/3/2014 6:43 PM
Terminations	Termination Effective Date	Insert				4/3/2014 6:43 PM
Terminations	Termination Reason	Insert				4/3/2014 6:43 PM