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SINGING RIVER SPECIALTY PHARMACY
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
SINGING RIVER SPECIALTY PHARMACY
Pharmacy Address
2809 DENNY AVE
PASCAGOULA, MS 39581-5301
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Heath Allen Thompson, Administrator Ancillary Services
(228) 818-1191
Contract Pharmacy Representative
Singing River Health System
Trang Nguyen, Pharmacy Manager
(228) 809-2230
Signed By Date
10/14/2022
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