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UNIVERSITY HOSPITAL & CLINICS
DSH250168 UMMC-GRENADA
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Covered Entity Details
Entity Name
UMMC-GRENADA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250168
Entity Address
960 AVENT DRIVE
GRENADA, MS 38901
Medicare Provider Number
250168
Participating Start Date
1/1/2018
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
UNIVERSITY HOSPITAL & CLINICS
Pharmacy Address
PHARMACY
350 W WOODROW WILSON AVE
JACKSON, MS 39213-7681
Pharmacy Comments
Contract Details
Approval Date
2/9/2022
Contract Begin Date
2/10/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dodie McElmurray, CEO
(662) 227-7005
Contract Pharmacy Representative
University Hospital & Clinics Pharmacy
Steven Dancer, Asst Director, Pharmacy
(601) 815-8902
Signed By Date
2/9/2022
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