Covered Entity Details

DSH250001E UNIVERSITY HOSPITALS AND CLINICS (Terminated) - information as of 6/19/2025 11:46:47 PM

Main Details

Name

UNIVERSITY HOSPITALS AND CLINICS

Subdivision Name

Communicative Sciences (JMM Audiology)

Type

Disproportionate Share Hospital

Rural

340B ID

DSH250001E

Medicare Provider Number

250001

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/15/2016

Participating Start Date

7/1/2016

Participating Approval Date

4/20/2016

Last Recertification Date

9/5/2016

Termination Date
Termination Reason

10/1/2016
Other

Contacts

Authorizing Official

University of MIssissippi Medical Center
Jeffrey Grimsley, CFO-Health System
(601) 815-6270

Primary Contact

University of Mississippi Medical Center
Todd Dear, Director of Pharmacy
(601) 984-2055

Addresses

Street Address

350 West Woodrow Wilson Avenue
Jackson, MS 39213

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
MS	00020149
		1154317527

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
DSH250001AA	Child	DSH	University of Mississippi Medical Center	Cancer Institute-Radiation Oncology	350 West Woodrow Wilson Avenue	Jackson	MS	Active
DSH250001AB	Child	DSH	University of Mississippi Medical Center	JMM Endocrinology	350 West Woodrow Wilson Avenue	Jackson	MS	Terminated
DSH250001AC	Child	DSH	University of Mississippi Medical Center	JMM Children's Clinic	350 West Woodrow Wilson Avenue	Jackson	MS	Terminated
DSH250001AD	Child	DSH	University of Mississippi Medical Center	Neurophysiology	2500 North State Street	Jackson	MS	Active
DSH250001AE	Child	DSH	University of Mississippi Medical Center	UH GI Lab	2500 North State Street	Jackson	MS	Active
DSH250001AF	Child	DSH	University of Mississippi Medical Center	Cancer Clinics - Cancer Clinics	350 West Woodrow Wilson Avenue	Jackson	MS	Active
DSH250001AG	Child	DSH	University of Mississippi Medical Center	Pavilion Transplant Clinic	2500 North State Street	Jackson	MS	Active
DSH250001AH	Child	DSH	University of Mississippi Medical Center	UMMC GI Lab - Belhaven - Gastroenterology	1405 North State Street	Jackson	MS	Terminated
DSH250001AJ	Child	DSH	University of Mississippi Medical Center	Pavilion Medicine Clinic Suite G - Pavilion Medicine Clinic Suite G	2500 North State Street	Jackson	MS	Active
DSH250001AK	Child	DSH	University of Mississippi Medical Center	STATE OF MISSISSIPPI - UNIVERSITY - CH Peds Urgent Care	1010 LAKELAND PL	FLOWOOD	MS	Active
DSH250001B	Child	DSH	University of Mississippi Medical Center	CANCER INSTITUTE	350 WEST WOODROW WILSON	JACKSON	MS	Active
DSH250001E	Child	DSH	UNIVERSITY HOSPITALS AND CLINICS	Communicative Sciences (JMM Audiology)	350 West Woodrow Wilson Avenue	Jackson	MS	Terminated
DSH250001F	Child	DSH	University of Mississippi Medical Center	SS Cardiac-Rehab Univ Heart	5903 Ridgewood Road	Jackson	MS	Active
DSH250001G	Child	DSH	University of Mississippi Medical Center	SS Select Heart Clinic	5903 Ridgewood Road	Jackson	MS	Active
DSH250001H	Child	DSH	University of Mississippi Medical Center	Center for Advancement of Youth	4400 Old Canton Road	Jackson	MS	Active
DSH250001J	Child	DSH	University of Mississippi Medical Center	SS Sleep Disorder Center	5903 Ridgewood Road	Jackson	MS	Active
DSH250001K	Child	DSH	University of Mississippi Medical Center	Dialysis-Home	350 West Woodrow Wilson Avenue	Jackson	MS	Active
DSH250001L	Child	DSH	University of Mississippi Medical Center	JMM Dialysis--Outpatient Mall	350 West Woodrow Wilson Avenue	Jackson	MS	Active
DSH250001M	Child	DSH	University of Mississippi Medical Center	Batson Kid's Clinic	421 South Stadium Drive	Jackson	MS	Active
DSH250001N	Child	DSH	University of Mississippi Medical Center	Batson Specialty Clinic	421 South Stadium Drive	Jackson	MS	Terminated
DSH250001P	Child	DSH	University of Mississippi Medical Center	JMM Pain Management Clinic-Mall	350 West Woodrow Wilson Avenue	Jackson	MS	Active
DSH250001Q	Child	DSH	University of Mississippi Medical Center	JMM Peds Allergy (Pediatric Allergy Clinic-Mall)	350 West Woodrow Wilson Avenue	Jackson	MS	Terminated
DSH250001R	Child	DSH	University of Mississippi Medical Center	JMM Surgical Specialty Clinic-Mall	350 West Woodrow Wilson Avenue	Jackson	MS	Active
DSH250001S	Child	DSH	University of Mississippi Medical Center	JMM Medicine Specialty Clinic-Mall	350 West Woodrow Wilson Avenue	Jackson	MS	Active
DSH250001T	Child	DSH	University of Mississippi Medical Center	JMM Bleeding Disorder Clinic (Hemostasis & Thrombosis Center)	350 West Woodrow Wilson	Jackson	MS	Terminated
DSH250001U	Child	DSH	University of Mississippi Medical Center	JMM Renal Clinic-Mall	350 West Woodrow Wilson	Jackson	MS	Active
DSH250001V	Child	DSH	University of Mississippi Medical Center	JMM-Anticoag (Pharmacy Care Clinic-Mall)	350 West Woodrow Wilson	Jackson	MS	Active
DSH250001W	Child	DSH	University of Mississippi Medical Center	JMM-Psychiatry Clinic (Mall)	350 West Woodrow Wilson	Jackson	MS	Terminated
DSH250001X	Child	DSH	University of Mississippi Medical Center	JMM OB/GYN Clinic-Mall	350 West Woodrow Wilson Avenue	Jackson	MS	Active
DSH250001Y	Child	DSH	University of Mississippi Medical Center	Infusion Center-Select	5903 Ridgewood Road	Jackson	MS	Active
DSH250001Z	Child	DSH	University of Mississippi Medical Center	Wound Care Center	2500 North State Street	Jackson	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Grimsley, Jeffrey Assistant CFO University of MIssissippi Medical Center 6018158732	Grimsley, Jeffrey CFO-Health System University of MIssissippi Medical Center 6018156270	5/4/2020 10:09 AM
Contacts	Signed By	Update	Profile Change Request	Grimsley, Jeffrey Assistant CFO University of MIssissippi Medical Center 6018158732	Grimsley, Jeffrey CFO-Health System University of MIssissippi Medical Center 6018156270	5/4/2020 10:09 AM
Contacts	Authorizing Official	Update	Profile Change Request	Grimsley, Jeffery Assistant CFO University of MIssissippi Medical Center 6018158732	Grimsley, Jeffrey Assistant CFO University of MIssissippi Medical Center 6018158732	10/23/2017 9:56 AM
Contacts	Signed By	Update	Profile Change Request	Grimsley, Jeffery Assistant CFO University of MIssissippi Medical Center 6018158732	Grimsley, Jeffrey Assistant CFO University of MIssissippi Medical Center 6018158732	10/23/2017 9:56 AM
Contacts	Authorizing Official	Update		Grimsley, Jeffery Assistant CFO 6018158732	Grimsley, Jeffery Assistant CFO University of MIssissippi Medical Center 6018158732	10/22/2017 9:04 PM
Contacts	Signed By	Update		Grimsley, Jeffery Assistant CFO 6018158732	Grimsley, Jeffery Assistant CFO University of MIssissippi Medical Center 6018158732	10/22/2017 9:04 PM
Contacts	Primary Contact	Update		Dear, Todd Director of Pharmacy 6019842055	Dear, Todd Director of Pharmacy University of Mississippi Medical Center 6019842055	10/20/2017 2:11 PM
Contacts	Primary Contact	Insert			Dear, Todd Director of Pharmacy 6019842055	5/1/2017 12:14 PM
Contacts	Authorizing Official	Insert			Grimsley, Jeffery Assistant CFO 6018158732	5/1/2017 12:14 PM
Contacts	Signed By	Insert			Grimsley, Jeffery Assistant CFO 6018158732	5/1/2017 12:14 PM
Addresses	Main Address	Insert			350 West Woodrow Wilson Avenue Jackson, MS 39213	9/5/2016 9:26 AM
Details	Last Recertification Date	Update			9/5/2016 12:00:00 AM	9/5/2016 9:26 AM
Dates	Last Date That 340B Drugs Purchased	Update			9/1/2016 12:00:00 AM	9/5/2016 9:26 AM
Details	State	Update		Active	Terminated	9/5/2016 9:26 AM
Terminations	Termination Comments	Update			Chose first choice based on conversation with Jose at Apexus at 1010 am. See reasoning below Due to lack of medications being given at this child site location and lack of prescriptions being generated, institutional decision has been made to unenroll this offsite child site.	9/5/2016 9:26 AM
Terminations	Termination Date	Update			10/1/2016 12:00:00 AM	9/5/2016 9:26 AM
Terminations	Termination Effective Date	Update			10/1/2016 12:00:00 AM	9/5/2016 9:26 AM
Terminations	Termination Reason	Update			Other	9/5/2016 9:26 AM
Dates	Participating Approval Date	Update			4/20/2016 12:00:00 AM	4/20/2016 1:46 PM
Details	State	Update		Pending	Active	4/20/2016 1:46 PM
Dates	Start Date	Update			7/1/2016 12:00:00 AM	4/20/2016 1:46 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_60680	DSH250001E	4/18/2016 8:30 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_60680	4/15/2016 5:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/15/2016 5:26 PM
Medicaid Billing	Medicaid: Number	Insert			00020149	4/15/2016 5:26 PM
Medicaid Billing	Medicaid: State	Insert			MS	4/15/2016 5:26 PM
Medicaid Billing	NPI: Number	Insert			1154317527	4/15/2016 5:26 PM
Details	Last Recertification Date	Insert				4/15/2016 5:26 PM
Details	Grant Number	Insert				4/15/2016 5:26 PM
Details	340B ID	Insert				4/15/2016 5:26 PM
Details	Is Authorizing Official EHB Data	Insert				4/15/2016 5:26 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/15/2016 5:26 PM
Details	Medicare Provider Number	Insert			250001	4/15/2016 5:26 PM
Details	Entity Name	Insert			UNIVERSITY HOSPITALS AND CLINICS	4/15/2016 5:26 PM
Details	Program Code	Insert			DSH	4/15/2016 5:26 PM
Details	Entity Subname	Insert			Communicative Sciences (JMM Audiology)	4/15/2016 5:26 PM
Dates	Participating Approval Date	Insert				4/15/2016 5:26 PM
Details	State	Insert			Pending	4/15/2016 5:26 PM
Dates	Registration Date	Insert			4/15/2016 12:00:00 AM	4/15/2016 5:26 PM
Dates	Signed By Date	Insert			4/15/2016 12:00:00 AM	4/15/2016 5:26 PM
Dates	Start Date	Insert				4/15/2016 5:26 PM
Terminations	Termination Comments	Insert				4/15/2016 5:26 PM
Terminations	Termination Date	Insert				4/15/2016 5:26 PM
Terminations	Termination Effective Date	Insert				4/15/2016 5:26 PM
Terminations	Termination Reason	Insert				4/15/2016 5:26 PM