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NOBLE HEALTH SERVICES INC.
DSH250058 SOUTH CENTRAL REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTH CENTRAL REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250058
Entity Address
1220 JEFFERSON STREET
LAUREL, MS 39440
Medicare Provider Number
250058
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
NOBLE HEALTH SERVICES INC.
Pharmacy Address
6040 TARBELL ROAD
SYRACUSE, NY 13206
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
7/21/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/25/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James T. Canizaro, CFO
(601) 399-6139
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
7/14/2021
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