340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
FRANCISCAN MISSIONARIES OF OUR LADY HEAL
DSH250048 ST. DOMINIC-JACKSON MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
ST. DOMINIC-JACKSON MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250048
Entity Address
969 LAKELAND DRIVE
JACKSON, MS 39216-4606
Medicare Provider Number
250048
Participating Start Date
7/1/2008
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
FRANCISCAN MISSIONARIES OF OUR LADY HEAL
Pharmacy Address
DBA RXONE ST DOMINIC
971 LAKELAND DR STE 101
JACKSON, MS 39216
Pharmacy Comments
Contract Details
Approval Date
7/5/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sam Scott, Sr Vice President / CFO
(601) 200-6570
Contract Pharmacy Representative
FMOLHS
Lance Bourgoyne, Director Retail Pharmacy
(225) 765-8140
Signed By Date
7/5/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session