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PLAZA PHARMACY INC
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
PLAZA PHARMACY INC
Pharmacy Address
4211 HOSPITAL ST STE 104
PASCAGOULA, MS 39581-5310
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/12/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Mike Crews, Chief Financial Officer
(228) 497-7590
Contract Pharmacy Representative
Plaza Pharmacy
Kenneth R. Clark, Owner
(228) 762-1940
Signed By Date
4/15/2013
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