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SPECIALTY CARE RX, LLC
DSH250040 SINGING RIVER HEALTH SYSTEM
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Covered Entity Details
Entity Name
SINGING RIVER HEALTH SYSTEM
Subdivision Name
SINGING RIVER HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH250040
Entity Address
2809 DENNY AVENUE
PASCAGOULA, MS 39581
Medicare Provider Number
250040
Participating Start Date
3/15/2022
Last Recertification Date
9/8/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
SPECIALTY CARE RX, LLC
Pharmacy Address
150 COLLINS ST
MEMPHIS, TN 38112
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/22/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Heath Allen Thompson, Administrator Ancillary Services
(228) 818-1191
Contract Pharmacy Representative
VitalRx
Ami Wittber, Main 340B POC
(615) 499-1837
Signed By Date
4/12/2019
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