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DSH250001AJ University of Mississippi Medical Center (Active)
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Main Details
Name
University of Mississippi Medical Center
Subdivision Name
Pavilion Medicine Clinic Suite G - Pavilion Medicine Clinic Suite G
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH250001AJ
Medicare Provider Number
250001
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/2/2020
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
University of MIssissippi Medical Center
Jeffrey Grimsley, CFO-Health System
(601) 815-6270
Primary Contact
University of Mississippi Medical Center
Stacy Baughn, Director Business Operations, Pharmacy
(601) 815-1791
Addresses
Street Address
2500 North State Street
Suite G
Jackson, MS 39216
Billing Address
University of Mississippi Medical Center
2500 North State Street
Attn: Pharmacy
Jackson, MS 39216
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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