Covered Entity Details

DSH250004G NORTH MISSISSIPPI MEDICAL CENTER (Active) - information as of 4/25/2025 8:34:03 PM

Main Details

Name

NORTH MISSISSIPPI MEDICAL CENTER

Subdivision Name

Breast Care Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH250004G

Medicare Provider Number

250004

Outpatient Facility Provider Number

250004

Additional Details

Current Program Status

Active

Registration Date

7/14/2014

Participating Start Date

10/1/2014

Participating Approval Date

8/29/2014

Last Recertification Date

9/6/2024

Contacts

Authorizing Official

North Mississippi Medical Center
BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229

Primary Contact

North Mississippi Medical Center
Patti Hawkins, Director
(662) 377-4731

Addresses

Street Address

4376 S Eason Blvd
Tupelo, MS 38801

Billing Address

North Mississippi Medical Center
830 South Gloster St
Tupelo, MS 38801

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?
No

Shipping Addresses

Shipping Address 1

North Mississippi Medical Center
830 South Gloster St
Tupelo, MS 38801

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
DSH250004A	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	NMMC OUTPATIENT INFUSION	990 SOUTH MADISON STREET, SUITE 2	TUPELO	MS	Active
DSH250004AA	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Children's Clinic Saltillo-RHC - Pediatrics	108 Desert Cove	Saltillo	MS	Terminated
DSH250004AB	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	GARFIELD CLINIC - Infectious Disease	806 GARFIELD ST	TUPELO	MS	Active
DSH250004AC	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Neurology Consultants Injection Services - Neurology	408 Council Circle Suite B	Tupelo	MS	Active
DSH250004AD	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	North MS Dermatology Clinic (Dermatology Consultants) - Dermatology Consultants	408 Council Cir Ste C	Tupelo	MS	Approved
DSH250004B	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	NMMC WOMEN'S CENTER	4566 S EASON BLVD	TUPELO	MS	Active
DSH250004D	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	NMMC Outpatient Infusion Annex	612 Brunson	Tupelo	MS	Terminated
DSH250004E	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Longtown/Pain Center	4381 South Eason Blvd	Tupelo	MS	Active
DSH250004F	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Behavioral Health	4579 S Eason Blvd	Tupelo	MS	Active
DSH250004G	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Breast Care Center	4376 S Eason Blvd	Tupelo	MS	Active
DSH250004H	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	NMMC Outpatient Infusion Oncology	959 S. Gloster St.	Tupelo	MS	Active
DSH250004J	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	NMMC Radiation Oncology	990 S. Madison St.	Tupelo	MS	Active
DSH250004K	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	HEMATOLOGY ONCOLOGY	961 SOUTH GLOSTER STREET	TUPELO	MS	Active
DSH250004L	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Neurosurgery	4381 S EASON BLVD	TUPELO	MS	Active
DSH250004M	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Pulmonary Consultants	860S MADISON ST	TUPELO	MS	Active
DSH250004N	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	dba NMMC Womens Center- OP-L&D - Labor and Delivery OP	4566 South Eason Blvd	Tupelo	MS	Active
DSH250004P	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	dba NMMC Outpatient Infusion-Home - home infusion specialty	738 S. Gloster St	Tupelo	MS	Active
DSH250004Q	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	dba NMMC Womens Center-Recovery - Recovery Room-OP	4566 South Eason Blvd	Tupelo	MS	Active
DSH250004R	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	dba NMMC Womens Center - Maternal Fetal Medicine	4566 South Eason Blvd	Tupelo	MS	Active
DSH250004S	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	dba NMMC Womens Center-Short Stay Surgery - Short Stay Surgery	4566 South Eason Blvd	Tupelo	MS	Active
DSH250004T	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	dba NMMC Womens Center-OB Emergency - OB Emergency	4566 South Eason Blvd	Tupelo	MS	Active
DSH250004U	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	dba NMMC Outpatient Infusion-Rheumatology - Rheumatology Specialty	990 South Madison Street, Suite 2	Tupelo	MS	Active
DSH250004V	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	NORTH MISSISSIPPI MEDICAL CENTER IN - North MS Retina Center	606 BRUNSON DRIVE	TUPELO	MS	Active
DSH250004W	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Rheumatology Consultants - Rheumatology	408 Council Circle Suite A	Tupelo	MS	Active
DSH250004X	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Diabetes Treatment Center - Diabetes and Endocrine Disorders	410 Council Circle	Tupelo	MS	Active
DSH250004Y	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Women's Center Respiratory Therapy - Respiratory therapy	4566 S Eason Blvd	Tupelo	MS	Active
DSH250004Z	Child	DSH	NORTH MISSISSIPPI MEDICAL CENTER	Children's Clinic Tupelo- RHC - Pediatrics	199 Grandstand Place, Suite 101	Tupelo	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/30/2023 9:05:14 PM	9/6/2024 1:54:54 PM	9/6/2024 1:54 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 6:50:06 PM	8/30/2023 9:05:14 PM	8/30/2023 9:05 PM
Details	Last Recertification Date	Update	Recertification	9/9/2021 5:49:09 PM	9/8/2022 6:50:06 PM	9/8/2022 6:50 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	Hos0004p (AL)		7/26/2022 5:29 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	00020081 (MS)		7/26/2022 5:29 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1598875460 (MS)		7/26/2022 5:29 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1598875460 (AL)		7/26/2022 5:29 PM
Details	Last Recertification Date	Update	Recertification	9/10/2020 2:58:10 PM	9/9/2021 5:49:09 PM	9/9/2021 5:49 PM
Medicaid Billing	NPI: State	Update	Recertification		MS	9/10/2020 2:58 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1598875460	9/10/2020 2:58 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/10/2020 2:58 PM
Details	Last Recertification Date	Update	Recertification	9/12/2019 2:57:47 PM	9/10/2020 2:58:10 PM	9/10/2020 2:58 PM
Medicaid Billing	Medicaid: Number	Update	Recertification	20081	00020081	9/12/2019 2:57 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1598875460	9/12/2019 2:57 PM
Details	Last Recertification Date	Update	Recertification	8/30/2018 1:30:38 PM	9/12/2019 2:57:47 PM	9/12/2019 2:57 PM
Addresses	Billing Address	Insert	Recertification		North Mississippi Medical Center 830 South Gloster St Tupelo, MS 38801	8/30/2018 1:30 PM
Addresses	Shipping Address	Insert	Recertification		North Mississippi Medical Center 830 South Gloster St Tupelo, MS 38801	8/30/2018 1:30 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/30/2018 1:30 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Hos0004p	8/30/2018 1:30 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AL	8/30/2018 1:30 PM
Details	Last Recertification Date	Update	Recertification	11/9/2017 10:24:08 AM	8/30/2018 1:30:38 PM	8/30/2018 1:30 PM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/9/2017 10:24:08 AM	11/9/2017 10:24 AM
Contacts	Authorizing Official	Update		TOPPIN, BRUCE J. GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY 6623774229	TOPPIN, BRUCE J. GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY North Mississippi Medical Center 6623774229	10/23/2017 11:20 AM
Contacts	Signed By	Update		TOPPIN, BRUCE J. GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY 6623774229	TOPPIN, BRUCE J. GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY North Mississippi Medical Center 6623774229	10/23/2017 11:20 AM
Contacts	Primary Contact	Update		Hawkins, Patti Director 6623774731	Hawkins, Patti Director North Mississippi Medical Center 6623774731	10/18/2017 11:51 AM
Addresses	Main Address	Insert			4376 S Eason Blvd Tupelo, MS 38801	7/24/2017 6:09 PM
Contacts	Primary Contact	Insert			Hawkins, Patti Director 6623774731	7/24/2017 6:09 PM
Contacts	Authorizing Official	Insert			TOPPIN, BRUCE J. GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY 6623774229	7/24/2017 6:09 PM
Contacts	Signed By	Insert			TOPPIN, BRUCE J. GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY 6623774229	7/24/2017 6:09 PM
Details	Last Recertification Date	Update		8/13/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 11:29 AM
Details	Last Recertification Date	Update			8/13/2015 12:00:00 AM	8/13/2015 10:42 AM
Dates	Participating Approval Date	Update			8/29/2014 12:00:00 AM	8/29/2014 3:44 PM
Details	State	Update		Pending	Active	8/29/2014 3:44 PM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	8/29/2014 3:44 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_45683	DSH250004G	8/20/2014 9:32 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_45683	7/14/2014 5:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/14/2014 5:23 PM
Medicaid Billing	Medicaid: Number	Insert			20081	7/14/2014 5:23 PM
Medicaid Billing	Medicaid: State	Insert			MS	7/14/2014 5:23 PM
Details	Last Recertification Date	Insert				7/14/2014 5:23 PM
Details	Grant Number	Insert				7/14/2014 5:23 PM
Details	340B ID	Insert				7/14/2014 5:23 PM
Details	Is Authorizing Official EHB Data	Insert				7/14/2014 5:23 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/14/2014 5:23 PM
Details	Medicare Provider Number	Insert			250004	7/14/2014 5:23 PM
Details	Entity Name	Insert			NORTH MISSISSIPPI MEDICAL CENTER	7/14/2014 5:23 PM
Details	Program Code	Insert			DSH	7/14/2014 5:23 PM
Details	Entity Subname	Insert			Breast Care Center	7/14/2014 5:23 PM
Dates	Participating Approval Date	Insert				7/14/2014 5:23 PM
Details	State	Insert			Pending	7/14/2014 5:23 PM
Dates	Registration Date	Insert			7/14/2014 12:00:00 AM	7/14/2014 5:23 PM
Dates	Signed By Date	Insert			7/14/2014 12:00:00 AM	7/14/2014 5:23 PM
Dates	Start Date	Insert				7/14/2014 5:23 PM
Terminations	Termination Comments	Insert				7/14/2014 5:23 PM
Terminations	Termination Date	Insert				7/14/2014 5:23 PM
Terminations	Termination Effective Date	Insert				7/14/2014 5:23 PM
Terminations	Termination Reason	Insert				7/14/2014 5:23 PM