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DSH250001E UNIVERSITY HOSPITALS AND CLINICS (Terminated)
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Main Details
Name
UNIVERSITY HOSPITALS AND CLINICS
Subdivision Name
Communicative Sciences (JMM Audiology)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH250001E
Medicare Provider Number
250001
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/20/2016
Last Recertification Date
9/5/2016
Termination Date
Termination Reason
10/1/2016
Other
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 Avenue
Jackson, MS 39213
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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