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DSH250001T University of Mississippi Medical Center (Terminated)
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Main Details
Name
University of Mississippi Medical Center
Subdivision Name
JMM Bleeding Disorder Clinic (Hemostasis & Thrombosis Center)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH250001T
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
9/5/2016
Termination Date
Termination Reason
1/1/2018
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
Todd Dear, Director of Pharmacy
(601) 984-2055
Addresses
Street Address
350 West Woodrow Wilson
Jackson, MS 39213
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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