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PLAZA PHARMACY INC
RRC250040-00 SINGING RIVER HEALTH SYSTEM
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Covered Entity Details
Entity Name
SINGING RIVER HEALTH SYSTEM
Subdivision Name
SINGING RIVER HOSPITAL
Type
Rural Referral Center
340B ID
RRC250040-00
Entity Address
2809 DENNY AVENUE
PASCAGOULA, MS 39581
Medicare Provider Number
250040
Participating Start Date
7/1/2024
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
PLAZA PHARMACY INC
Pharmacy Address
4211 HOSPITAL ST STE 104
PASCAGOULA, MS 39581-5310
Pharmacy Comments
Contract Details
Approval Date
11/18/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Heath Allen Thompson, Administrator Ancillary Services
(228) 818-1191
Contract Pharmacy Representative
Plaza Pharmacy
Kenneth R. Clark, Owner
(228) 762-1940
Signed By Date
10/14/2020
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