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DSH250001W University of Mississippi Medical Center (Terminated)
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Main Details
Name
University of Mississippi Medical Center
Subdivision Name
JMM-Psychiatry Clinic (Mall)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH250001W
Medicare Provider Number
250001
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/7/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/20/2016
Last Recertification Date
9/6/2022
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
University of MIssissippi Medical Center
Jeffrey Grimsley, CFO-Health System
(601) 815-6270
Primary Contact
University of Mississippi Medical Center
Kelsey H Raymer, Health System 340B Operations Director
(601) 984-2676
Addresses
Street Address
350 West Woodrow Wilson
Jackson, MS 39213
Billing Address
University of Mississippi Medical Center
2500 North State Street
Jackson, MS 39216
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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