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LOVE'S PHARMACY #2, INC
DSH250019 MEMORIAL HOSPITAL AT GULFPORT
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL AT GULFPORT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250019
Entity Address
4500 Thirteenth Street
GULFPORT, MS 39501
Medicare Provider Number
250019
Participating Start Date
7/1/2000
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
LOVE'S PHARMACY #2, INC
Pharmacy Address
LOVE'S PHARMACY, INC
45000 E ALOHA DR
SUITE B
DIAMONDHEAD, MS 39525
Pharmacy Comments
Contract Details
Approval Date
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kent Nicaud, President and Chief Executive Officer
(228) 867-4046
Contract Pharmacy Representative
Love's Pharmacy
Russell Love, Owner
(228) 255-7800
Signed By Date
10/12/2022
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