340B Drug Pricing Program Database
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DSH250019CG MEMORIAL HOSPITAL AT GULFPORT (Terminated)
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Main Details
Name
MEMORIAL HOSPITAL AT GULFPORT
Subdivision Name
Memorial Family Practice- Walk-In Clinic- Walmart Lane
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250019CG
Medicare Provider Number
250019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
8/17/2023
Termination Date
Termination Reason
1/1/2024
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
189 C Walmart Lane
Biloxi, MS 39531
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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12/31/14 Corrected typo in 340B ID.
12/31/2014
April 2025
April 2025
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