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WALMART PHARMACY 10-4586
DSH250123 SINGING RIVER GULFPORT
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Covered Entity Details
Entity Name
SINGING RIVER GULFPORT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250123
Entity Address
15200 COMMUNITY ROAD
GULFPORT, MS 39503-5307
Medicare Provider Number
250123
Participating Start Date
3/11/2022
Last Recertification Date
8/28/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-4586
Pharmacy Address
1820-A POPPS FERRY ROAD
BILOXI, MS 39532
Pharmacy Comments
Contract Details
Approval Date
4/5/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Heath Allen Thompson, Administrator Ancillary Services
(228) 818-1191
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
4/5/2022
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