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NORTH MISSISSIPPI MEDICAL CENTER INC
DSH250025 MONROE HEALTH SERVICES INC.
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Covered Entity Details
Entity Name
MONROE HEALTH SERVICES INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250025
Entity Address
1105 EARL FRYE BLVD
AMORY, MS 38821
Medicare Provider Number
250025
Participating Start Date
7/1/2021
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
NORTH MISSISSIPPI MEDICAL CENTER INC
Pharmacy Address
DBA NMMC SPECIALTY PHARMACY
738 S GLOSTER ST
SUITE B
TUPELO, MS 38801
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229
Contract Pharmacy Representative
North Mississippi Health Services
GICHELLE CLARK, DIVISION MANAGER
(662) 377-4352
Signed By Date
4/15/2024
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