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DSH250001AC University of Mississippi Medical Center (Terminated)
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Main Details
Name
University of Mississippi Medical Center
Subdivision Name
JMM Children's Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH250001AC
Medicare Provider Number
250001
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/13/2017
Last Recertification Date
9/14/2020
Termination Date
Termination Reason
10/1/2021
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
University of MIssissippi Medical Center
Jeffrey Grimsley, CFO-Health System
(601) 815-6270
Primary Contact
University of Mississippi Medical Center
William E Mayhood, Supervisor-340b Compliance
(601) 984-2676
Addresses
Street Address
350 West Woodrow Wilson Avenue
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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