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DSH250019HY MEMORIAL HOSPITAL AT GULFPORT (Terminated)
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Main Details
Name
MEMORIAL HOSPITAL AT GULFPORT
Subdivision Name
Memorial Physician Clinics Bay St. Louis General Surgery and Multispecialty - Orthopedic Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH250019HY
Medicare Provider Number
250019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2023
Participating Start Date
7/1/2023
Participating Approval Date
5/3/2023
Last Recertification Date
8/17/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
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
833 Highway 90, Suite 1
Bay St. Louis, MS 39520
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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