Covered Entity Details

DSH250067F CLAY COUNTY MEDICAL CORPORATION (Approved) - information as of 5/7/2025 10:42:05 PM

Main Details

Name

CLAY COUNTY MEDICAL CORPORATION

Subdivision Name

North Mississippi Retina Center West Point - Retina Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH250067F

Medicare Provider Number

250067

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/14/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/30/2025

Last Recertification Date

Contacts

Authorizing Official

North Mississippi Medical Center
BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229

Primary Contact

North Mississippi Medical Center
Patti Hawkins, Director
(662) 377-4731

Addresses

Street Address

187 Medical Center Drive
West Point, MS 38858-0428

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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?
Yes

State	Medicaid Number	NPI Number
MS	200014980,000020079	1639284409,1174353247

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH250067A	Child	DSH	CLAY COUNTY MEDICAL CORPORATION	Cancer Care-Starkville Outpatient Infusion	1205 Highway 182 West	Starkville	MS	Active
DSH250067B	Child	DSH	CLAY COUNTY MEDICAL CORPORATION	Cancer Care- Starkville - Medical Oncology	1205 Highway 182 West	Starkville	MS	Active
DSH250067C	Child	DSH	CLAY COUNTY MEDICAL CORPORATION	Cancer Care- Starkville - Radiation Oncology	1205 Highway 182 West	Starkville	MS	Active
DSH250067D	Child	DSH	CLAY COUNTY MEDICAL CORPORATION	West Point Children's Clinic - Pediatrics	63 Medical Center Drive	West Point	MS	Active
DSH250067E	Child	DSH	CLAY COUNTY MEDICAL CORPORATION	CLAY COUNTY MEDICAL CORPORATION - West Point Internal Medicine Clinic PA-RHC	977 EMERGENCY DR	WEST POINT	MS	Active
DSH250067F	Child	DSH	CLAY COUNTY MEDICAL CORPORATION	North Mississippi Retina Center West Point - Retina Center	187 Medical Center Drive	West Point	MS	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		TOPPIN, BRUCE J. GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY North Mississippi Medical Center 6623774229	4/30/2025 3:44 PM
Details	340B ID	Update	New Registration		DSH250067F	4/30/2025 3:44 PM
Details	Entity Subname	Update	New Registration	North Mississippi Retina Center West Point	North Mississippi Retina Center West Point - Retina Center	4/30/2025 3:44 PM
Dates	Participating Approval Date	Update	New Registration		4/30/2025 3:44:44 PM	4/30/2025 3:44 PM
Details	State	Update	New Registration	Pending	Approved	4/30/2025 3:44 PM
Dates	Signed By Date	Update	New Registration		4/14/2025 11:47:21 PM	4/30/2025 3:44 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/30/2025 3:44 PM
Addresses	Main Address	Insert	New Registration		187 Medical Center Drive West Point, MS 38858-0428	4/14/2025 9:49 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 9:49 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		200014980	4/14/2025 9:49 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	4/14/2025 9:49 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2025 9:49 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000020079	4/14/2025 9:49 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	4/14/2025 9:49 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1174353247	4/14/2025 9:49 AM
Medicaid Billing	NPI: State	Insert	New Registration		MS	4/14/2025 9:49 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1639284409	4/14/2025 9:49 AM
Medicaid Billing	NPI: State	Insert	New Registration		MS	4/14/2025 9:49 AM
Contacts	Primary Contact	Insert	New Registration		Hawkins, Patti Director North Mississippi Medical Center 6623774731	4/14/2025 9:49 AM
Contacts	Authorizing Official	Insert	New Registration		TOPPIN, BRUCE J. GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY North Mississippi Medical Center 6623774229	4/14/2025 9:49 AM
Details	Assistance Received From Date	Insert	New Registration			4/14/2025 9:49 AM
Details	Assistance Received To Date	Insert	New Registration			4/14/2025 9:49 AM
Details	Last Recertification Date	Insert	New Registration			4/14/2025 9:49 AM
Details	Grant Number	Insert	New Registration			4/14/2025 9:49 AM
Details	340B ID	Insert	New Registration			4/14/2025 9:49 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2025 9:49 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2025 9:49 AM
Details	Medicare Provider Number	Insert	New Registration		250067	4/14/2025 9:49 AM
Details	Entity Name	Insert	New Registration		CLAY COUNTY MEDICAL CORPORATION	4/14/2025 9:49 AM
Details	NOFO Number	Insert	New Registration			4/14/2025 9:49 AM
Details	Program Code	Insert	New Registration		DSH	4/14/2025 9:49 AM
Details	Entity Subname	Insert	New Registration		North Mississippi Retina Center West Point	4/14/2025 9:49 AM
Dates	Participating Approval Date	Insert	New Registration			4/14/2025 9:49 AM
Details	State	Insert	New Registration		Pending	4/14/2025 9:49 AM
Dates	Registration Date	Insert	New Registration		4/14/2025 9:49:01 AM	4/14/2025 9:49 AM
Dates	Signed By Date	Insert	New Registration			4/14/2025 9:49 AM
Dates	Start Date	Insert	New Registration			4/14/2025 9:49 AM
Terminations	Termination Comments	Insert	New Registration			4/14/2025 9:49 AM
Terminations	Termination Date	Insert	New Registration			4/14/2025 9:49 AM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2025 9:49 AM
Terminations	Termination Reason	Insert	New Registration			4/14/2025 9:49 AM