Covered Entity Details

DSH250104N ANDERSON REGIONAL MEDICAL CENTER (Active) - information as of 4/30/2025 10:54:56 PM

Main Details

Name

ANDERSON REGIONAL MEDICAL CENTER

Subdivision Name

Anderson IMC Family Medicine Clinic - Family Medicine

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH250104N

Medicare Provider Number

250104

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/12/2022

Participating Start Date

7/1/2022

Participating Approval Date

4/22/2022

Last Recertification Date

9/5/2024

Contacts

Authorizing Official

Baptist Memorial Health Care Corporation
Cyndi Pittman, VP Financial Operations
(901) 227-8480

Primary Contact

Baptist Memorial Health Care Corp
Donna C Cox, Director 340B
(901) 227-5144

Addresses

Street Address

1600 22nd Ave.
Meridian, MS 39301

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	00927547,00020046	1932248853,1649226952
AL	JEF089IN	1649226952

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
DSH250104A	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson Express Care Clinic	1523 22nd Avenue	Meridian	MS	Active
DSH250104B	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson Cancer Center - Oncology	1704 23rd Avenue	Meridian	MS	Active
DSH250104C	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson Endocrinology and Diabetes Center	2024 15th Street	Meridian	MS	Active
DSH250104D	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	ANDERSON UROLOGY CLINIC OF MERIDIAN - Anderson Urology	1600 22ND AVENUE	MERIDIAN	MS	Active
DSH250104E	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson Rheumatology Center - Rheumatology	2024 15th Street	Meridian	MS	Active
DSH250104F	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson MMA Family Medicine Clinic - Family Medicine	2024 15th Street	Meridian	MS	Active
DSH250104G	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson MMA Internal Medicine Clinic - Internal Medicine	2024 15th Street	Meridian	MS	Active
DSH250104H	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson MMA Nephrology Clinic	2024 15th Street	Meridian	MS	Active
DSH250104J	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson MMA Family Medicine Clinic - Collinsville - Family Medicine	8985 Church Road	Collinsville	MS	Active
DSH250104K	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson MMA Gastroenterology Clinic - Gastroenterology	2024 15th Street	Meridian	MS	Active
DSH250104L	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson MMA Pulmonology Clinic - Pulmonology	2024 15th Street	Meridian	MS	Active
DSH250104M	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson Neurology Clinic - Neurology	1516 23rd Avenue	Meridian	MS	Terminated
DSH250104N	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson IMC Family Medicine Clinic - Family Medicine	1600 22nd Ave.	Meridian	MS	Active
DSH250104P	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson IMC Gastroenterology Clinic - Gastroenterology	1600 22nd Ave.	Meridian	MS	Active
DSH250104Q	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson IMC Nephrology Clinic - Nephrology	1600 22nd Ave.	Meridian	MS	Active
DSH250104R	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson IMC Podiatry Clinic - Podiatry	1600 22nd Ave.	Meridian	MS	Active
DSH250104S	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson IMC Pulmonary Clinic - Pulmonology	1600 22nd Ave.	Meridian	MS	Active
DSH250104T	Child	DSH	ANDERSON REGIONAL MEDICAL CENTER	Anderson Outpatient Infusion Center - Intravenous Therapy	2024 15th Street	Meridian	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/11/2025 4:52 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		JEF089IN	3/11/2025 4:52 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	3/11/2025 4:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1649226952	3/11/2025 4:52 PM
Medicaid Billing	NPI: State	Insert	Change Request		AL	3/11/2025 4:52 PM
Contacts	Primary Contact	Update	Group Change Request	Moore, Holly DIRECTOR OF INPATIENT PHARMACY Anderson Regional Medical Center 6015536606	Cox, Donna C Director 340B Baptist Memorial Health Care Corp 9012275144	12/10/2024 4:28 PM
Contacts	Authorizing Official	Update	Change Request	Anderson, John Administrator/CEO Anderson Regional Medical Center 6015536104	Pittman, Cyndi VP Financial Operations Baptist Memorial Health Care Corporation 9012278480	12/9/2024 7:11 AM
Contacts	Authorizing Official	Update	Change Request	Anderson, John G. CEO Anderson Regional Medical Center 6015536104	Anderson, John Administrator/CEO Anderson Regional Medical Center 6015536104	12/5/2024 2:34 PM
Contacts	Primary Contact	Update	Group Change Request	MOORE, HOLLY DIRECTOR OF INPATIENT PHARMACY Anderson Regional Medical Center 6015536606	Moore, Holly DIRECTOR OF INPATIENT PHARMACY Anderson Regional Medical Center 6015536606	12/3/2024 3:34 PM
Details	Last Recertification Date	Update	Recertification	8/24/2023 10:08:11 AM	9/5/2024 1:18:00 PM	9/5/2024 1:18 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/5/2024 2:25 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00020046	6/5/2024 2:25 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	6/5/2024 2:25 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1649226952	6/5/2024 2:25 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	6/5/2024 2:25 PM
Details	Last Recertification Date	Update	Recertification	9/1/2022 10:20:39 AM	8/24/2023 10:08:11 AM	8/24/2023 10:08 AM
Details	Last Recertification Date	Update	Recertification		9/1/2022 10:20:39 AM	9/1/2022 10:20 AM
Details	State	Update		Approved	Active	7/1/2022 12:01 AM
Addresses	Main Address	Insert	New Registration		1600 22nd Ave. Meridian, MS 39301	4/22/2022 2:16 PM
Contacts	Signed By	Insert	New Registration		Anderson, John G. CEO Anderson Regional Medical Center 6015536104	4/22/2022 2:16 PM
Details	340B ID	Update	New Registration		DSH250104N	4/22/2022 2:16 PM
Details	Entity Name	Update	New Registration	JEFF ANDERSON REGIONAL MEDICAL CENTE	ANDERSON REGIONAL MEDICAL CENTER	4/22/2022 2:16 PM
Details	Entity Subname	Update	New Registration	Anderson IMC Family Medicine	Anderson IMC Family Medicine Clinic - Family Medicine	4/22/2022 2:16 PM
Dates	Participating Approval Date	Update	New Registration		4/22/2022 2:16:51 PM	4/22/2022 2:16 PM
Details	State	Update	New Registration	Pending	Approved	4/22/2022 2:16 PM
Dates	Signed By Date	Update	New Registration		4/12/2022 5:19:12 PM	4/22/2022 2:16 PM
Dates	Start Date	Update	New Registration		7/1/2022 12:00:00 AM	4/22/2022 2:16 PM
Addresses	Main Address	Insert	New Registration		1600 22nd Ave. Meridian, MS 39301	4/12/2022 1:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2022 1:39 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		00927547	4/12/2022 1:39 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	4/12/2022 1:39 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1932248853	4/12/2022 1:39 PM
Medicaid Billing	NPI: State	Insert	New Registration		MS	4/12/2022 1:39 PM
Contacts	Primary Contact	Insert	New Registration		MOORE, HOLLY DIRECTOR OF INPATIENT PHARMACY Anderson Regional Medical Center 6015536606	4/12/2022 1:39 PM
Contacts	Authorizing Official	Insert	New Registration		Anderson, John G. CEO Anderson Regional Medical Center 6015536104	4/12/2022 1:39 PM
Details	Assistance Received From Date	Insert	New Registration			4/12/2022 1:39 PM
Details	Assistance Received To Date	Insert	New Registration			4/12/2022 1:39 PM
Details	Last Recertification Date	Insert	New Registration			4/12/2022 1:39 PM
Details	Grant Number	Insert	New Registration			4/12/2022 1:39 PM
Details	340B ID	Insert	New Registration			4/12/2022 1:39 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/12/2022 1:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/12/2022 1:39 PM
Details	Medicare Provider Number	Insert	New Registration		250104	4/12/2022 1:39 PM
Details	Entity Name	Insert	New Registration		JEFF ANDERSON REGIONAL MEDICAL CENTE	4/12/2022 1:39 PM
Details	NOFO Number	Insert	New Registration			4/12/2022 1:39 PM
Details	Program Code	Insert	New Registration		DSH	4/12/2022 1:39 PM
Details	Entity Subname	Insert	New Registration		Anderson IMC Family Medicine	4/12/2022 1:39 PM
Dates	Participating Approval Date	Insert	New Registration			4/12/2022 1:39 PM
Details	State	Insert	New Registration		Pending	4/12/2022 1:39 PM
Dates	Registration Date	Insert	New Registration		4/12/2022 1:39:57 PM	4/12/2022 1:39 PM
Dates	Signed By Date	Insert	New Registration			4/12/2022 1:39 PM
Dates	Start Date	Insert	New Registration			4/12/2022 1:39 PM
Terminations	Termination Comments	Insert	New Registration			4/12/2022 1:39 PM
Terminations	Termination Date	Insert	New Registration			4/12/2022 1:39 PM
Terminations	Termination Effective Date	Insert	New Registration			4/12/2022 1:39 PM
Terminations	Termination Reason	Insert	New Registration			4/12/2022 1:39 PM