340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH250019W MEMORIAL HOSPITAL AT GULFPORT (Terminated)
Print
Main Details
Name
MEMORIAL HOSPITAL AT GULFPORT
Subdivision Name
Memorial Lyman Family Practice
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250019W
Medicare Provider Number
250019
Outpatient Facility Provider Number
DSH700
Additional Details
Current Program Status
Terminated
Registration Date
4/19/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/25/2012
Last Recertification Date
9/6/2016
Termination Date
Termination Reason
7/1/2017
Site closure
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
20006 Hwy 53
Gulfport, MS 39503
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session