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VANDERBILT HEALTH PHARMACY GROUP
DSH250001 University of Mississippi Medical Center
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Covered Entity Details
Entity Name
University of Mississippi Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250001
Entity Address
2500 NORTH STATE ST.
JACKSON, MS 39216
Medicare Provider Number
250001
Participating Start Date
4/1/1998
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
VANDERBILT HEALTH PHARMACY GROUP
Pharmacy Address
718 MELROSE AVE
NASHVILLE, TN 37211-3721
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Jeffrey Grimsley, CFO-Health System
(601) 815-6270
Contract Pharmacy Representative
Vanderbilt Health Pharmacy Group
James R Manfred, Executive Director, VHPG
(615) 322-4775
Signed By Date
10/15/2018
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