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DSH250019ES MEMORIAL HOSPITAL AT GULFPORT (Active)
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Main Details
Name
MEMORIAL HOSPITAL AT GULFPORT
Subdivision Name
Memorial Physician Clinics Digestive Health Ocean Springs - Gastroenterology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250019ES
Medicare Provider Number
250019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/2/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/8/2024
Last Recertification Date
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
3890 Bienville Boulevard
Ocean Springs, MS 39564
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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Participating Start Date7/1/2018, Termination 1/1/2023, Reinstatement 1/1/2025
10/08/2024
April 2025
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