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DSH250058E SOUTH CENTRAL REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Subdivision Name
South Central Outpatient Infusion Services / Cancer Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250058E
Medicare Provider Number
250058
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2013
Participating Start Date
4/1/2013
Participating Approval Date
1/14/2013
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
7/1/2024
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
South Central Regional Medical Center
James T. Canizaro, CFO
(601) 399-6139
Primary Contact
South Central Regional Medical Center
Gary C Lott, Director Of Pharmacy
(601) 426-4024
Addresses
Street Address
1203 Jefferson Street
Laurel, MS 39440
Billing Address
South Central Outpatient Infusion Services / Cancer Center
P.O. Box 607
Laurel, MS 39441-0607
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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