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FRED'S PHARMACY #3146
DSH250040 SINGING RIVER HEALTH SYSTEM
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Covered Entity Details
Entity Name
SINGING RIVER HEALTH SYSTEM
Subdivision Name
SINGING RIVER HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH250040
Entity Address
2809 DENNY AVENUE
PASCAGOULA, MS 39581
Medicare Provider Number
250040
Participating Start Date
3/15/2022
Last Recertification Date
9/8/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
FRED'S PHARMACY #3146
Pharmacy Address
12101 HWY 57
VANCLEAVE, MS 39565
Pharmacy Comments
Contract Details
Approval Date
1/11/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/6/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Heath Allen Thompson, Administrator Ancillary Services
(228) 818-1191
Contract Pharmacy Representative
Fred's Pharmacy
Nicole Pearson, 340B Program Manager
(901) 500-6153
Signed By Date
1/11/2018
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