Covered Entity Details

CH04910Q NORTH MS PRIMARY HEALTH CARE INC (Active) - information as of 5/17/2025 10:48:17 PM

Main Details

Name

NORTH MS PRIMARY HEALTH CARE INC

Subdivision Name

NMPHC Holly Springs

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039231

340B ID

CH04910Q

Grant Number

H80CS00635

Additional Details

Current Program Status

Active

Registration Date

11/5/2024

Participating Start Date

1/1/2025

Participating Approval Date

11/6/2024

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

North Mississippi Primary Health Care
Bill Stone, CEO
(662) 502-3149

Primary Contact

North Mississippi Primary Health Care, Inc.
Reeca Elliott, 340B Program Coordinator
(662) 502-3150

Addresses

Street Address

1705 Crescent Meadows Dr
Holly Springs, MS 38635

Billing Address

North Mississippi Primary Healthcare
15921 Boundary Dr
ASHLAND, MS 38663

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH049100	Active	BPS-H80-004768	NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.	Benton Medical Center	15921 Boundary Dr	Ashland	MS
CH04910A	Active	BPS-H80-002941	NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.	WALNUT MEDICAL CENTER	531 Main Street	WALNUT	MS
CH04910B	Active	BPS-H80-011509	NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.	Ripley Health Care Associates	749 S Line St	RIPLEY	MS
CH04910C	Active	BPS-H80-001265	NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.	Booneville Community Health Center	208 N 1st St	Booneville	MS
CH04910D	Active	BPS-H80-039979	NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.	Corinth Health Care Associates	1010 S Harper Rd	Corinth	MS
CH04910E	Active	BPS-H80-030810	NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.	New Albany Health Care Associates	488 W Bankhead St	New Albany	MS
CH04910F	Active	BPS-H80-011270	North Mississippi Primary Health Care, Inc.	Mobile Unit	15921 Boundary Dr	Ashland	MS
CH04910G	Active	BPS-H80-018463	North Mississippi Primary Health Care, Inc.	Tishomingo Health Care Associates	1310 Main Street	Tishomingo	MS
CH04910H	Active	BPS-H80-027733	North Mississippi Primary Health Care, Inc.	Oxford Health Care Associates	2716 West Oxford Loop STE 171	Oxford	MS
CH04910J	Active	BPS-H80-032009	North Mississippi Primary Health Care, Inc.	Charger Health and Wellness	399 N 5th St	Oxford	MS
CH04910K	Active	BPS-H80-036138	NORTH MS PRIMARY HEALTH CARE INC	Walnut Imaging Center	71 Mitchell Ave	Walnut	MS
CH04910L	Active	BPS-H80-036160	NORTH MS PRIMARY HEALTH CARE INC	Walnut Dental Center	521 Main St	Walnut	MS
CH04910M	Active	BPS-H80-027839	NORTH MS PRIMARY HEALTH CARE INC	NMPHC Wellness Center	16025 Boundary Dr	Ashland	MS
CH04910N	Active	BPS-H80-035233	NORTH MS PRIMARY HEALTH CARE INC	James D Nunnally Center for Community Health Excellence	751 S Line St	Ripley	MS
CH04910P	Active	BPS-H80-033827	NORTH MS PRIMARY HEALTH CARE INC	NMPHC Multi-Specialty Telehealth Center	15931 Boundary Dr	Ashland	MS
CH04910Q	Active	BPS-H80-039231	NORTH MS PRIMARY HEALTH CARE INC	NMPHC Holly Springs	1705 Crescent Meadows Dr	Holly Springs	MS

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH049100	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2024	04/29/2025
CH049100	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2024
CH049100	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2024
CH049100	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2024
CH049100	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2024
CH049100	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2024	04/29/2025
CH049100	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/01/2025
CH049100	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	07/01/2017	04/12/2023
CH049100	ASHLAND DISCOUNT DRUG	15917 BOUNDARY DRIVE	PO BOX 126	ASHLAND	MS	38603	01/01/2006
CH04910F	ASHLAND DISCOUNT DRUG	15917 BOUNDARY DRIVE	PO BOX 126	ASHLAND	MS	38603	01/01/2024
CH049100	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	07/01/2017	07/14/2020
CH049100	BARNETT APOTHECARY	606 BATTLEGROUND DR.		IUKA	MS	38852	01/01/2025
CH049100	BELMONT PHARMACY, LLC	338 2ND ST	PO BOX 876	BELMONT	MS	38827	07/01/2023
CH049100	BOONEVILLE COMMUNITY PHARMACY	206 N 2ND ST		BOONEVILLE	MS	38829-2702	01/01/2017
CH04910C	BOONEVILLE COMMUNITY PHARMACY	206 N 2ND ST		BOONEVILLE	MS	38829-2702	04/01/2006
CH04910E	BOONEVILLE COMMUNITY PHARMACY	206 N 2ND ST		BOONEVILLE	MS	38829-2702	01/01/2024
CH049100	BURNSVILLE DISCOUNT DRUGS	603 S HIGHWAY 365		BURNSVILLE	MS	38833	01/01/2025
CH049100	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2025
CH049100	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2025
CH049100	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2025
CH049100	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2025
CH049100	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2025
CH049100	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2025
CH049100	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2025
CH049100	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2025
CH049100	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2025
CH049100	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2025
CH049100	CHANEY'S PHARMACY	501 BRAMLETT BLVD		OXFORD	MS	38655	04/01/2024
CH049100	COX BLYTHE HEALTHCARE GROUP CORP.	DBA / COX-BLYTHE DRUG COMPANY	122 W COLLEGE ST	BOONEVILLE	MS	38829	10/01/2020
CH04910M	COX BLYTHE HEALTHCARE GROUP CORP.	DBA / COX-BLYTHE DRUG COMPANY	122 W COLLEGE ST	BOONEVILLE	MS	38829	04/01/2024
CH049100	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2025
CH049100	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2025
CH049100	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2025
CH049100	DAVIDSON DISCOUNT PHARMACY	DAVIDSON PHARMACY	203 NORTH SECOND STREET	BOONEVILLE	MS	38829	07/01/2019	05/02/2020
CH049100	DUNCAN'S PHARMACY INC	28271 HIGHWAY 15	P.O. BOX 220	WALNUT	MS	38683-8930	01/01/2017
CH04910A	DUNCAN'S PHARMACY INC	28271 HIGHWAY 15	P.O. BOX 220	WALNUT	MS	38683-8930	04/01/2006
CH04910H	DUNCAN'S PHARMACY INC	28271 HIGHWAY 15	P.O. BOX 220	WALNUT	MS	38683-8930	01/01/2024
CH049100	G & M OF OXFORD INC	2159 S LAMAR BLVD		OXFORD	MS	38655-5223	05/02/2019	02/26/2021
CH049100	G & M OF OXFORD INC	2159 S LAMAR BLVD		OXFORD	MS	38655-5223	07/01/2024
CH049100	G & M PHARMACY INC	2159 S LAMAR		OXFORD	MS	38655	07/01/2019	05/02/2019
CH049100	GATLIN'S PHARMACY		18 FIRST STREET PO BOX 369	TISHOMINGO	MS	38873	06/01/2011	10/01/2016
CH049100	GATLIN'S PHARMACY	18 FIRST AVE	PO BOX 369	TISHOMINGO	MS	38873-8441	10/01/2016
CH04910B	GATLIN'S PHARMACY	18 FIRST AVE	PO BOX 369	TISHOMINGO	MS	38873-8441	01/01/2024
CH049100	GUNN DRUG COMPANY	1815 E SHILOH RD		CORINTH	MS	38834	07/01/2024
CH049100	HOLLIS DISCOUNT PHARMACY	1008 CITY AVE N		RIPLEY	MS	38663-1413	01/01/2017	07/22/2018
CH04910B	HOLLIS DISCOUNT PHARMACY	1008 CITY AVE N		RIPLEY	MS	38663-1413	01/01/2017	07/22/2018
CH049100	HOLLIS DISCOUNT PHARMACY	1008 CITY AVE N		RIPLEY	MS	38663-1413	01/01/2023
CH04910L	HOLLIS DISCOUNT PHARMACY	1008 CITY AVE N		RIPLEY	MS	38663-1413	04/01/2024
CH049100	HOSPITAL PHARMACY, INC		212 HIGHWAY 30 WEST	NEW ALBANY	MS	38652-3112	01/01/2017	06/17/2017
CH049100	IUKA DISCOUNT DRUGS	1411 W QUITMAN ST		IUKA	MS	38852-1130	07/01/2019	10/27/2020
CH049100	IUKA DISCOUNT DRUGS	1411 W QUITMAN ST		IUKA	MS	38852-1130	10/27/2020
CH04910J	IUKA DISCOUNT DRUGS	1411 W QUITMAN ST		IUKA	MS	38852-1130	01/01/2024
CH049100	KROGER FOOD & DRUG #454	104 HWY 72 WEST		CORINTH	MS	38834	01/01/2025
CH049100	KROGER FOOD & PHARMACY #473	2013 UNIVERSITY AVE		OXFORD	MS	38655	01/01/2025
CH049100	KROGER FOOD AND DRUG #387	240 NEW BYHALIA ROAD		COLLIERVILLE	TN	38017	01/01/2025
CH049100	Kroger Pharmacy	Jeffersonville Central Fill Facility	301 Logistics Ave Suite 200	Jeffersonville	IN	47130	01/01/2025
CH049100	MANTACHIE PHARMACY, LLC	3309 HIGHWAY 371 N		MANTACHIE	MS	38855-7267	01/01/2025
CH049100	MEDICAL PLAZA ON HARPER	1425 S HARPER RD		CORINTH	MS	38834-6613	02/01/2012
CH04910A	MEDICAL PLAZA ON HARPER	1425 S HARPER RD		CORINTH	MS	38834-6613	01/01/2024
CH049100	MEDICAL PLAZA PHARMACY	111 ALCORN DR		CORINTH	MS	38834-9359	07/01/2024	12/10/2024
CH049100	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04536	301 AMERICAN AVENUE	BOONEVILLE	MS	38829	01/01/2024
CH049100	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07065	135 HIGHWAY15, NORTH	PONTOTOC	MS	38863	01/01/2024
CH049100	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 8273	750 CITY AVE SOUTH	RIPLEY	MS	38663	01/01/2024
CH049100	MISSISSIPPI CVS PHARMACY, L.L.C.	CVS/PHARMACY # 11085	575 CRAFT ST	HOLLY SPRINGS	MS	38635	01/01/2024
CH049100	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 6031	1912 JACKSON AVE. W	OXFORD	MS	38655	01/01/2025
CH049100	NEW ALBANY PHARMACY AND SOLUTIONS	140 FAIRFIELD		NEW ALBANY	MS	38652	07/01/2019	05/02/2020
CH049100	OPTUM PHARMACY 800, INC.	3016 GUADALUPE ST STE A		AUSTIN	TX	78705-2861	07/01/2017	12/01/2020
CH049100	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/14/2020	12/01/2020
CH049100	OXFORD RX	705 N LAMAR BLVD		OXFORD	MS	38655	10/01/2020
CH04910C	OXFORD RX	705 N LAMAR BLVD		OXFORD	MS	38655	01/01/2024
CH049100	POTTS CAMP FAMILY PHARMACY	41 S CENTER ST	PO BOX 10	POTTS CAMP	MS	38659-9531	07/01/2019	05/02/2020
CH049100	POTTS CAMP FAMILY PHARMACY	41 S CENTER ST	PO BOX 10	POTTS CAMP	MS	38659-9531	07/01/2024
CH049100	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2025
CH049100	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2025
CH049100	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2025
CH049100	RIPLEY DRUG CO	1010 CITY AVE N	P.O. BOX 415	RIPLEY	MS	38663-1413	01/01/2017
CH04910B	RIPLEY DRUG CO	1010 CITY AVE N	P.O. BOX 415	RIPLEY	MS	38663-1413	04/01/2006
CH04910G	RIPLEY DRUG CO	1010 CITY AVE N	P.O. BOX 415	RIPLEY	MS	38663-1413	01/01/2024
CH049100	RUSHING DRUG COMPANY	1519 W QUITMAN ST		IUKA	MS	38852	01/01/2025
CH049100	SALTILLO PHARMACY	2698 HWY 145		SALTILLO	MS	38866	07/01/2019	05/02/2020
CH049100	SALTILLO PHARMACY AND SOLUTIONS	2698 HIGHWAY 145		SALTILLO	MS	38866-6941	01/01/2025
CH049100	SHILOH APOTHECARY INC.	2049 E SHILOH RD		CORINTH	MS	38834	04/01/2024
CH049100	SMITH DRUG & HOME MEDICAL,INC	100 S SECOND ST		BOONEVILLE	MS	38829	07/01/2019	12/23/2019
CH049100	SMITH DRUGS OF BOONEVILLE LLC	DBA/ SMITH DRUG & HOME MEDICAL	100 S SECOND ST	BOONEVILLE	MS	38829-3225	12/09/2019
CH04910K	SMITH DRUGS OF BOONEVILLE LLC	DBA/ SMITH DRUG & HOME MEDICAL	100 S SECOND ST	BOONEVILLE	MS	38829-3225	04/01/2024
CH049100	SQUARE PHARMACY AND GIFTS OF BELMONT	85 MAIN ST		BELMONT	MS	38827-9750	01/01/2025
CH049100	SSD, LLC	498 W BANKHEAD ST		NEW ALBANY	MS	38652-3319	01/01/2017
CH04910E	SSD, LLC	498 W BANKHEAD ST		NEW ALBANY	MS	38652-3319	01/01/2017
CH04910D	SSD, LLC	498 W BANKHEAD ST		NEW ALBANY	MS	38652-3319	01/01/2024
CH049100	TYSON DRUGS INC	145 E VAN DORN AVE	P.O. BOX 10	HOLLY SPRINGS	MS	38635-3025	07/01/2019
CH049100	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019
CH049100	WAL-MART PHARMACY 10-0114	300 WALMART WAY CIRCLE		BOONEVILLE	MS	38829	04/01/2019
CH049100	WAL-MART PHARMACY 10-0153	202 PARK PLAZA		NEW ALBANY	MS	38652	04/01/2019
CH049100	WAL-MART PHARMACY 10-0176	822 CITY AVE SOUTH		RIPLEY	MS	38663	04/01/2019
CH049100	WAL-MART PHARMACY 10-0274	1110 BATTLEGROUND DRIVE		IUKA	MS	38852	04/01/2019
CH049100	WAL-MART PHARMACY 10-0303	950 MACKIE DR		HOLLY SPRINGS	MS	38635	04/01/2019
CH049100	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/01/2021	05/06/2025
CH049100	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019
CH049100	WALGREEN CO	DBA: WALGREENS #12436	225 HWY 30 W	NEW ALBANY	MS	38652-3129	01/01/2024
CH049100	WALGREEN CO	DBA: WALGREENS #11290	834 BARNES CROSSING RD	TUPELO	MS	38804-0909	01/01/2024
CH049100	WALGREEN CO.	DBA: WALGREENS # 01913	2026 HWY 72 E	CORINTH	MS	38834-6709	01/01/2024
CH049100	WALGREEN CO.	DBA: WALGREENS # 07757	1808 UNIVERSITY AVE	OXFORD	MS	38655-4112	01/01/2024
CH049100	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #11600	601 SKYLINE DR.	JACKSON	TN	38301	01/01/2024
CH049100	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15317	1424 UNION AVE	MEMPHIS	TN	38104	01/01/2024
CH049100	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2025
CH049100	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Elliott, Reeca 340B Program Coordinator North Mississippi Primary Health Care, Inc. 6624719444	Elliott, Reeca 340B Program Coordinator North Mississippi Primary Health Care, Inc. 6625023150	4/7/2025 3:18 PM
Details	Last Recertification Date	Update	Recertification		2/11/2025 9:36:01 AM	2/11/2025 9:36 AM
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	09011971 (MS)		11/20/2024 4:19 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1467286468 (MS)		11/20/2024 4:19 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1821092552 (MS)		11/20/2024 4:19 PM
Contacts	Signed By	Insert	New Registration		Stone, Bill CEO North Mississippi Primary Health Care 6625023149	11/6/2024 1:24 PM
Details	340B ID	Update	New Registration		CH04910Q	11/6/2024 1:24 PM
Dates	Participating Approval Date	Update	New Registration		11/6/2024 1:24:33 PM	11/6/2024 1:24 PM
Details	State	Update	New Registration	Pending	Approved	11/6/2024 1:24 PM
Dates	Signed By Date	Update	New Registration		11/5/2024 3:14:21 PM	11/6/2024 1:24 PM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	11/6/2024 1:24 PM
Addresses	Main Address	Insert	New Registration		1705 Crescent Meadows Dr Holly Springs, MS 38635	11/5/2024 2:22 PM
Addresses	Billing Address	Insert	New Registration		North Mississippi Primary Healthcare 15921 Boundary Dr ASHLAND, MS 38663	11/5/2024 2:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	11/5/2024 2:22 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		09011971	11/5/2024 2:22 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	11/5/2024 2:22 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467286468	11/5/2024 2:22 PM
Medicaid Billing	NPI: State	Insert	New Registration		MS	11/5/2024 2:22 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1821092552	11/5/2024 2:22 PM
Medicaid Billing	NPI: State	Insert	New Registration		MS	11/5/2024 2:22 PM
Contacts	Authorizing Official	Insert	New Registration		Stone, Bill CEO North Mississippi Primary Health Care 6625023149	11/5/2024 2:22 PM
Contacts	Primary Contact	Insert	New Registration		Elliott, Reeca 340B Program Coordinator North Mississippi Primary Health Care, Inc. 6624719444	11/5/2024 2:22 PM
Details	Assistance Received From Date	Insert	New Registration			11/5/2024 2:22 PM
Details	Assistance Received To Date	Insert	New Registration			11/5/2024 2:22 PM
Details	Last Recertification Date	Insert	New Registration			11/5/2024 2:22 PM
Details	Grant Number	Insert	New Registration		H80CS00635	11/5/2024 2:22 PM
Details	340B ID	Insert	New Registration			11/5/2024 2:22 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			11/5/2024 2:22 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			11/5/2024 2:22 PM
Details	Medicare Provider Number	Insert	New Registration			11/5/2024 2:22 PM
Details	Entity Name	Insert	New Registration		NORTH MS PRIMARY HEALTH CARE INC	11/5/2024 2:22 PM
Details	NOFO Number	Insert	New Registration			11/5/2024 2:22 PM
Details	Program Code	Insert	New Registration		CH	11/5/2024 2:22 PM
Details	Entity Subname	Insert	New Registration		NMPHC Holly Springs	11/5/2024 2:22 PM
Dates	Participating Approval Date	Insert	New Registration			11/5/2024 2:22 PM
Details	State	Insert	New Registration		Pending	11/5/2024 2:22 PM
Dates	Registration Date	Insert	New Registration		11/5/2024 2:22:15 PM	11/5/2024 2:22 PM
Dates	Signed By Date	Insert	New Registration			11/5/2024 2:22 PM
Dates	Start Date	Insert	New Registration			11/5/2024 2:22 PM
Terminations	Termination Comments	Insert	New Registration			11/5/2024 2:22 PM
Terminations	Termination Date	Insert	New Registration			11/5/2024 2:22 PM
Terminations	Termination Effective Date	Insert	New Registration			11/5/2024 2:22 PM
Terminations	Termination Reason	Insert	New Registration			11/5/2024 2:22 PM

340B Drug Pricing Program Database