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DSH250019KE MEMORIAL HOSPITAL AT GULFPORT (Approved)
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Main Details
Name
MEMORIAL HOSPITAL AT GULFPORT
Subdivision Name
Memorial Physician Clinics Three River Multispecialty - Cardiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250019KE
Medicare Provider Number
250019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/4/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/7/2025
Last Recertification Date
Contacts
Authorizing Official
Memorial Hospital at Gulfport
Kent Nicaud, President and Chief Executive Officer
(228) 867-4046
Primary Contact
Memorial Hospital at Gulfport
Brian Clark, Outpatient Pharmacy Director
(228) 867-4485
Addresses
Street Address
9424 Three Rivers Road, Suite B
Gulfport, MS 39503
Billing Address
Memorial Hospital at Gulfport
4500 13th Street
Gulfport, MS 39501
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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