340B Drug Pricing Program Database


CH04910C NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC. (Active) - information as of 5/3/2025 11:28:03 PM

Main Details
NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
Booneville Community Health Center
HRSA-Funded Health Center
BPS-H80-001265
CH04910C
H80CS00635


Additional Details
Active
1/12/2006
4/1/2006
1/13/2006
2/11/2025

Contacts

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

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

Addresses

208 N 1st St
Booneville, MS 38829-2718

NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.
PO BOX 92
ASHLAND, MS 38603


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailBOONEVILLE COMMUNITY PHARMACY206 N 2ND ST
BOONEVILLEMS38829-270204/01/200604/01/2006  03/28/2013
Contract DetailOXFORD RX705 N LAMAR BLVD
OXFORDMS3865510/16/202301/01/2024  01/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH049100ActiveBPS-H80-004768NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.Benton Medical Center15921 Boundary Dr AshlandMS
CH04910AActiveBPS-H80-002941NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.WALNUT MEDICAL CENTER531 Main Street WALNUTMS
CH04910BActiveBPS-H80-011509NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.Ripley Health Care Associates749 S Line St RIPLEYMS
CH04910CActiveBPS-H80-001265NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.Booneville Community Health Center208 N 1st St BoonevilleMS
CH04910DActiveBPS-H80-039979NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.Corinth Health Care Associates1010 S Harper Rd CorinthMS
CH04910EActiveBPS-H80-030810NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.New Albany Health Care Associates488 W Bankhead St New AlbanyMS
CH04910FActiveBPS-H80-011270North Mississippi Primary Health Care, Inc.Mobile Unit15921 Boundary Dr AshlandMS
CH04910GActiveBPS-H80-018463North Mississippi Primary Health Care, Inc.Tishomingo Health Care Associates1310 Main Street TishomingoMS
CH04910HActiveBPS-H80-027733North Mississippi Primary Health Care, Inc.Oxford Health Care Associates2716 West Oxford Loop STE 171 OxfordMS
CH04910JActiveBPS-H80-032009North Mississippi Primary Health Care, Inc.Charger Health and Wellness399 N 5th St OxfordMS
CH04910KActiveBPS-H80-036138NORTH MS PRIMARY HEALTH CARE INCWalnut Imaging Center71 Mitchell Ave WalnutMS
CH04910LActiveBPS-H80-036160NORTH MS PRIMARY HEALTH CARE INCWalnut Dental Center521 Main St WalnutMS
CH04910MActiveBPS-H80-027839NORTH MS PRIMARY HEALTH CARE INCNMPHC Wellness Center16025 Boundary Dr AshlandMS
CH04910NActiveBPS-H80-035233NORTH MS PRIMARY HEALTH CARE INCJames D Nunnally Center for Community Health Excellence751 S Line St RipleyMS
CH04910PActiveBPS-H80-033827NORTH MS PRIMARY HEALTH CARE INCNMPHC Multi-Specialty Telehealth Center15931 Boundary Dr AshlandMS
CH04910QActiveBPS-H80-039231NORTH MS PRIMARY HEALTH CARE INCNMPHC Holly Springs1705 Crescent Meadows Dr Holly SpringsMS
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH049100ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/01/2024  
CH049100ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/01/2024  
CH049100ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/01/2024  
CH049100ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/01/2024  
CH049100ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/01/2024  
CH049100ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/01/2024  
CH049100ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280901/01/2025  
CH049100AHSSHCEXPEDIEN RX PHARMACY 5050 WESLEY RD STE 120
APOPKAFL3271207/01/2017 04/12/2023
CH049100ASHLAND DISCOUNT DRUG15917 BOUNDARY DRIVE PO BOX 126
ASHLANDMS3860301/01/2006  
CH04910FASHLAND DISCOUNT DRUG15917 BOUNDARY DRIVE PO BOX 126
ASHLANDMS3860301/01/2024  
CH049100AVELLA OF DEER VALLEY, INC. #38DBA AVELLA SPECIALTY PHARMACY 24416 N. 19TH AVE
PHOENIXAZ8508507/01/2017 07/14/2020
CH049100BARNETT APOTHECARY606 BATTLEGROUND DR.
IUKAMS3885201/01/2025  
CH049100BELMONT PHARMACY, LLC338 2ND ST PO BOX 876
BELMONTMS3882707/01/2023  
CH049100BOONEVILLE COMMUNITY PHARMACY206 N 2ND ST
BOONEVILLEMS38829-270201/01/2017  
CH04910CBOONEVILLE COMMUNITY PHARMACY206 N 2ND ST
BOONEVILLEMS38829-270204/01/2006  
CH04910EBOONEVILLE COMMUNITY PHARMACY206 N 2ND ST
BOONEVILLEMS38829-270201/01/2024  
CH049100BURNSVILLE DISCOUNT DRUGS603 S HIGHWAY 365
BURNSVILLEMS3883301/01/2025  
CH049100CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/01/2025  
CH049100CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/01/2025  
CH049100CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/01/2025  
CH049100CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/01/2025  
CH049100CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/01/2025  
CH049100CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/01/2025  
CH049100CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/01/2025  
CH049100CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/01/2025  
CH049100CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/01/2025  
CH049100CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/01/2025  
CH049100CHANEY'S PHARMACY501 BRAMLETT BLVD
OXFORDMS3865504/01/2024  
CH049100COX BLYTHE HEALTHCARE GROUP CORP.DBA / COX-BLYTHE DRUG COMPANY 122 W COLLEGE ST
BOONEVILLEMS3882910/01/2020  
CH04910MCOX BLYTHE HEALTHCARE GROUP CORP.DBA / COX-BLYTHE DRUG COMPANY 122 W COLLEGE ST
BOONEVILLEMS3882904/01/2024  
CH049100CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870601/01/2025  
CH049100CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005601/01/2025  
CH049100CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/01/2025  
CH049100DAVIDSON DISCOUNT PHARMACYDAVIDSON PHARMACY 203 NORTH SECOND STREET
BOONEVILLEMS3882907/01/2019 05/02/2020
CH049100DUNCAN'S PHARMACY INC28271 HIGHWAY 15 P.O. BOX 220
WALNUTMS38683-893001/01/2017  
CH04910ADUNCAN'S PHARMACY INC28271 HIGHWAY 15 P.O. BOX 220
WALNUTMS38683-893004/01/2006  
CH04910HDUNCAN'S PHARMACY INC28271 HIGHWAY 15 P.O. BOX 220
WALNUTMS38683-893001/01/2024  
CH049100G & M OF OXFORD INC2159 S LAMAR BLVD
OXFORDMS38655-522305/02/2019 02/26/2021
CH049100G & M OF OXFORD INC2159 S LAMAR BLVD
OXFORDMS38655-522307/01/2024  
CH049100G & M PHARMACY INC2159 S LAMAR
OXFORDMS3865507/01/2019 05/02/2019
CH049100GATLIN'S PHARMACY  18 FIRST STREET
PO BOX 369 		TISHOMINGOMS3887306/01/2011 10/01/2016
CH049100GATLIN'S PHARMACY18 FIRST AVE PO BOX 369
TISHOMINGOMS38873-844110/01/2016  
CH04910BGATLIN'S PHARMACY18 FIRST AVE PO BOX 369
TISHOMINGOMS38873-844101/01/2024  
CH049100GUNN DRUG COMPANY1815 E SHILOH RD
CORINTHMS3883407/01/2024  
CH049100HOLLIS DISCOUNT PHARMACY1008 CITY AVE N
RIPLEYMS38663-141301/01/2017 07/22/2018
CH04910BHOLLIS DISCOUNT PHARMACY1008 CITY AVE N
RIPLEYMS38663-141301/01/2017 07/22/2018
CH049100HOLLIS DISCOUNT PHARMACY1008 CITY AVE N
RIPLEYMS38663-141301/01/2023  
CH04910LHOLLIS DISCOUNT PHARMACY1008 CITY AVE N
RIPLEYMS38663-141304/01/2024  
CH049100HOSPITAL PHARMACY, INC  212 HIGHWAY 30 WEST
NEW ALBANYMS38652-311201/01/2017 06/17/2017
CH049100IUKA DISCOUNT DRUGS1411 W QUITMAN ST
IUKAMS38852-113007/01/2019 10/27/2020
CH049100IUKA DISCOUNT DRUGS1411 W QUITMAN ST
IUKAMS38852-113010/27/2020  
CH04910JIUKA DISCOUNT DRUGS1411 W QUITMAN ST
IUKAMS38852-113001/01/2024  
CH049100KROGER FOOD & DRUG #454104 HWY 72 WEST
CORINTHMS3883401/01/2025  
CH049100KROGER FOOD & PHARMACY #4732013 UNIVERSITY AVE
OXFORDMS3865501/01/2025  
CH049100KROGER FOOD AND DRUG #387240 NEW BYHALIA ROAD
COLLIERVILLETN3801701/01/2025  
CH049100Kroger PharmacyJeffersonville Central Fill Facility 301 Logistics Ave
Suite 200 		JeffersonvilleIN4713001/01/2025  
CH049100MANTACHIE PHARMACY, LLC3309 HIGHWAY 371 N
MANTACHIEMS38855-726701/01/2025  
CH049100MEDICAL PLAZA ON HARPER1425 S HARPER RD
CORINTHMS38834-661302/01/2012  
CH04910AMEDICAL PLAZA ON HARPER1425 S HARPER RD
CORINTHMS38834-661301/01/2024  
CH049100MEDICAL PLAZA PHARMACY111 ALCORN DR
CORINTHMS38834-935907/01/2024 12/10/2024
CH049100MISSISSIPPI CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04536 301 AMERICAN AVENUE
BOONEVILLEMS3882901/01/2024  
CH049100MISSISSIPPI CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07065 135 HIGHWAY15, NORTH
PONTOTOCMS3886301/01/2024  
CH049100MISSISSIPPI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 8273 750 CITY AVE SOUTH
RIPLEYMS3866301/01/2024  
CH049100MISSISSIPPI CVS PHARMACY, L.L.C.CVS/PHARMACY # 11085 575 CRAFT ST
HOLLY SPRINGSMS3863501/01/2024  
CH049100MISSISSIPPI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 6031 1912 JACKSON AVE. W
OXFORDMS3865501/01/2025  
CH049100NEW ALBANY PHARMACY AND SOLUTIONS140 FAIRFIELD
NEW ALBANYMS3865207/01/2019 05/02/2020
CH049100OPTUM PHARMACY 800, INC.3016 GUADALUPE ST STE A
AUSTINTX78705-286107/01/2017 12/01/2020
CH049100OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/14/2020 12/01/2020
CH049100OXFORD RX705 N LAMAR BLVD
OXFORDMS3865510/01/2020  
CH04910COXFORD RX705 N LAMAR BLVD
OXFORDMS3865501/01/2024  
CH049100POTTS CAMP FAMILY PHARMACY41 S CENTER ST PO BOX 10
POTTS CAMPMS38659-953107/01/2019 05/02/2020
CH049100POTTS CAMP FAMILY PHARMACY41 S CENTER ST PO BOX 10
POTTS CAMPMS38659-953107/01/2024  
CH049100PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/01/2025  
CH049100PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920301/01/2025  
CH049100PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/01/2025  
CH049100RIPLEY DRUG CO1010 CITY AVE N P.O. BOX 415
RIPLEYMS38663-141301/01/2017  
CH04910BRIPLEY DRUG CO1010 CITY AVE N P.O. BOX 415
RIPLEYMS38663-141304/01/2006  
CH04910GRIPLEY DRUG CO1010 CITY AVE N P.O. BOX 415
RIPLEYMS38663-141301/01/2024  
CH049100RUSHING DRUG COMPANY1519 W QUITMAN ST
IUKAMS3885201/01/2025  
CH049100SALTILLO PHARMACY2698 HWY 145
SALTILLOMS3886607/01/2019 05/02/2020
CH049100SALTILLO PHARMACY AND SOLUTIONS2698 HIGHWAY 145
SALTILLOMS38866-694101/01/2025  
CH049100SHILOH APOTHECARY INC.2049 E SHILOH RD
CORINTHMS3883404/01/2024  
CH049100SMITH DRUG & HOME MEDICAL,INC100 S SECOND ST
BOONEVILLEMS3882907/01/2019 12/23/2019
CH049100SMITH DRUGS OF BOONEVILLE LLCDBA/ SMITH DRUG & HOME MEDICAL 100 S SECOND ST
BOONEVILLEMS38829-322512/09/2019  
CH04910KSMITH DRUGS OF BOONEVILLE LLCDBA/ SMITH DRUG & HOME MEDICAL 100 S SECOND ST
BOONEVILLEMS38829-322504/01/2024  
CH049100SQUARE PHARMACY AND GIFTS OF BELMONT85 MAIN ST
BELMONTMS38827-975001/01/2025  
CH049100SSD, LLC498 W BANKHEAD ST
NEW ALBANYMS38652-331901/01/2017  
CH04910ESSD, LLC498 W BANKHEAD ST
NEW ALBANYMS38652-331901/01/2017  
CH04910DSSD, LLC498 W BANKHEAD ST
NEW ALBANYMS38652-331901/01/2024  
CH049100TYSON DRUGS INC145 E VAN DORN AVE P.O. BOX 10
HOLLY SPRINGSMS38635-302507/01/2019  
CH049100WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2019  
CH049100WAL-MART PHARMACY 10-0114300 WALMART WAY CIRCLE
BOONEVILLEMS3882904/01/2019  
CH049100WAL-MART PHARMACY 10-0153202 PARK PLAZA
NEW ALBANYMS3865204/01/2019  
CH049100WAL-MART PHARMACY 10-0176822 CITY AVE SOUTH
RIPLEYMS3866304/01/2019  
CH049100WAL-MART PHARMACY 10-02741110 BATTLEGROUND DRIVE
IUKAMS3885204/01/2019  
CH049100WAL-MART PHARMACY 10-0303950 MACKIE DR
HOLLY SPRINGSMS3863504/01/2019  
CH049100WAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281904/01/2021  
CH049100WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2019  
CH049100WALGREEN CODBA: WALGREENS #12436 225 HWY 30 W
NEW ALBANYMS38652-312901/01/2024  
CH049100WALGREEN CODBA: WALGREENS #11290 834 BARNES CROSSING RD
TUPELOMS38804-090901/01/2024  
CH049100WALGREEN CO.DBA: WALGREENS # 01913 2026 HWY 72 E
CORINTHMS38834-670901/01/2024  
CH049100WALGREEN CO.DBA: WALGREENS # 07757 1808 UNIVERSITY AVE
OXFORDMS38655-411201/01/2024  
CH049100WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #11600 601 SKYLINE DR.
JACKSONTN3830101/01/2024  
CH049100WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15317 1424 UNION AVE
MEMPHISTN3810401/01/2024  
CH049100Walgreens #21389Walgreens Central Fill #21389 3299 Tchulatech Dr
Suite 101 		MemphisTN3811807/01/2025  
CH049100Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateProfile Change RequestElliott, Reeca 340B Program Coordinator North Mississippi Primary Health Care, Inc. 6624719444Elliott, Reeca 340B Program Coordinator North Mississippi Primary Health Care, Inc. 66250231504/7/2025 3:18 PM
DetailsLast Recertification DateUpdateRecertification2/4/2024 12:49:51 PM2/11/2025 9:32:56 AM2/11/2025 9:32 AM
Medicaid BillingMedicaid: NumberDeleteChange Request09015882 (MS) 11/20/2024 4:20 PM
Medicaid BillingMedicaid: NumberDeleteChange Request09011971 (MS) 11/20/2024 4:20 PM
Medicaid BillingNPI: NumberDeleteChange Request1821092552 (MS) 11/20/2024 4:20 PM
Medicaid BillingNPI: NumberDeleteChange Request1083009450 (MS) 11/20/2024 4:20 PM
DetailsLast Recertification DateUpdateRecertification2/10/2023 2:45:30 PM2/4/2024 12:49:51 PM2/4/2024 12:49 PM
ContactsPrimary ContactUpdateGroup Change RequestNunnally, Christina Kent Chief Quality Officer North Mississippi Primary Health Care, Inc. 6625023156Elliott, Reeca 340B Program Coordinator North Mississippi Primary Health Care, Inc. 66247194449/15/2023 9:46 AM
ContactsAuthorizing OfficialUpdateAO Change RequestNunnally, Miles D Chief Executive Officer North Mississippi Primary Health Care, Inc. 6625023140Stone, Bill CEO North Mississippi Primary Health Care 66250231499/13/2023 4:18 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/10/2023 2:45 PM
Medicaid BillingMedicaid: NumberInsertRecertification 090119712/10/2023 2:45 PM
Medicaid BillingMedicaid: StateInsertRecertification MS2/10/2023 2:45 PM
Medicaid BillingMedicaid: NumberDeleteRecertification09011971 (MS) 2/10/2023 2:45 PM
Medicaid BillingNPI: NumberDeleteRecertification1063078079 (MS) 2/10/2023 2:45 PM
Medicaid BillingNPI: NumberDeleteRecertification1275980211 (MS) 2/10/2023 2:45 PM
Medicaid BillingNPI: NumberDeleteRecertification1376938746 (MS) 2/10/2023 2:45 PM
Medicaid BillingNPI: NumberDeleteRecertification1740676378 (MS) 2/10/2023 2:45 PM
Medicaid BillingNPI: NumberDeleteRecertification1902292410 (MS) 2/10/2023 2:45 PM
Medicaid BillingNPI: NumberDeleteRecertification1992190367 (MS) 2/10/2023 2:45 PM
Medicaid BillingNPI: NumberDeleteRecertification1346833829 (MS) 2/10/2023 2:45 PM
DetailsLast Recertification DateUpdateRecertification2/8/2022 5:23:27 PM2/10/2023 2:45:30 PM2/10/2023 2:45 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestNUNNALLY, JAMES D. EXECUTIVE DIRECTOR NMPHC 6622248951-230Nunnally, Miles D Chief Executive Officer North Mississippi Primary Health Care, Inc. 66250231401/25/2023 9:27 AM
DetailsLast Recertification DateUpdateRecertification2/25/2021 5:07:44 PM2/8/2022 5:23:27 PM2/8/2022 5:23 PM
Medicaid BillingNPI: StateUpdateRecertification MS2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1619258019 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1023529443 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1245638642 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1538532528 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1821628405 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberInsertRecertification 10630780792/25/2021 5:07 PM
Medicaid BillingNPI: StateInsertRecertification MS2/25/2021 5:07 PM
Medicaid BillingNPI: NumberInsertRecertification 10830094502/25/2021 5:07 PM
Medicaid BillingNPI: StateInsertRecertification MS2/25/2021 5:07 PM
Medicaid BillingNPI: NumberInsertRecertification 12759802112/25/2021 5:07 PM
Medicaid BillingNPI: StateInsertRecertification MS2/25/2021 5:07 PM
Medicaid BillingNPI: NumberInsertRecertification 13769387462/25/2021 5:07 PM
Medicaid BillingNPI: StateInsertRecertification MS2/25/2021 5:07 PM
Medicaid BillingNPI: NumberInsertRecertification 17406763782/25/2021 5:07 PM
Medicaid BillingNPI: StateInsertRecertification MS2/25/2021 5:07 PM
Medicaid BillingNPI: NumberInsertRecertification 19022924102/25/2021 5:07 PM
Medicaid BillingNPI: StateInsertRecertification MS2/25/2021 5:07 PM
Medicaid BillingNPI: NumberInsertRecertification 19921903672/25/2021 5:07 PM
Medicaid BillingNPI: StateInsertRecertification MS2/25/2021 5:07 PM
Medicaid BillingNPI: NumberInsertRecertification 13468338292/25/2021 5:07 PM
Medicaid BillingNPI: StateInsertRecertification MS2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1871801795 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1962795815 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1922047729 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1013267152 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1013167352 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1396727590 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1730129404 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1588619621 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1548683790 ( ) 2/25/2021 5:07 PM
Medicaid BillingNPI: NumberDeleteRecertification1144731985 ( ) 2/25/2021 5:07 PM
DetailsLast Recertification DateUpdateRecertification1/30/2020 3:10:44 PM2/25/2021 5:07:44 PM2/25/2021 5:07 PM
Medicaid BillingNPI: NumberInsertRecertification 18210925521/30/2020 3:10 PM
Medicaid BillingNPI: NumberInsertRecertification 16192580191/30/2020 3:10 PM
Medicaid BillingNPI: NumberInsertRecertification 10235294431/30/2020 3:10 PM
Medicaid BillingNPI: NumberInsertRecertification 12456386421/30/2020 3:10 PM
Medicaid BillingNPI: NumberInsertRecertification 15385325281/30/2020 3:10 PM
Medicaid BillingNPI: NumberInsertRecertification 18216284051/30/2020 3:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1558315408 ( ) 1/30/2020 3:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1669464863 ( ) 1/30/2020 3:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1033531942 ( ) 1/30/2020 3:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1164477261 ( ) 1/30/2020 3:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1083009450 ( ) 1/30/2020 3:10 PM
DetailsLast Recertification DateUpdateRecertification2/6/2019 5:56:35 PM1/30/2020 3:10:44 PM1/30/2020 3:10 PM
DetailsLast Recertification DateUpdateRecertification2/9/2018 5:00:12 PM2/6/2019 5:56:35 PM2/6/2019 5:56 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False10/4/2018 3:09 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0901588210/4/2018 3:09 PM
Medicaid BillingMedicaid: StateInsertChange Request MS10/4/2018 3:09 PM
Medicaid BillingMedicaid: NumberUpdateChange Request90119710901197110/4/2018 3:09 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/9/2018 5:00 PM
Medicaid BillingMedicaid: NumberInsertRecertification 90119712/9/2018 5:00 PM
Medicaid BillingMedicaid: StateInsertRecertification MS2/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 18718017952/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 19627958152/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 19220477292/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 10132671522/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 10131673522/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 15583154082/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 13967275902/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 16694648632/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 10335319422/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 17301294042/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 15886196212/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 15486837902/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 11447319852/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 11644772612/9/2018 5:00 PM
Medicaid BillingNPI: NumberInsertRecertification 10830094502/9/2018 5:00 PM
DetailsLast Recertification DateUpdateRecertification1/25/2017 12:00:00 AM2/9/2018 5:00:12 PM2/9/2018 5:00 PM
ContactsAuthorizing OfficialUpdate NUNNALLY, JAMES D. EXECUTIVE DIRECTOR 6622248951-230NUNNALLY, JAMES D. EXECUTIVE DIRECTOR NMPHC 6622248951-23010/16/2017 11:59 AM
ContactsPrimary ContactUpdate Nunnally, Christina Chief Quality Officer 6625023156Nunnally, Christina Kent Chief Quality Officer North Mississippi Primary Health Care, Inc. 66250231569/28/2017 11:38 AM
ContactsAuthorizing OfficialUpdate NUNNALLY, JAMES D. CEO 6622248951-230NUNNALLY, JAMES D. EXECUTIVE DIRECTOR 6622248951-2304/14/2017 1:13 PM
AddressesMain AddressInsert   208 N 1st St Booneville, MS 38829-27181/25/2017 2:56 PM
ContactsPrimary ContactUpdate CHAPMAN, PATRICK Program Administrator 6622248951-239Nunnally, Christina Chief Quality Officer 66250231561/25/2017 2:56 PM
DetailsLast Recertification DateUpdate 2/12/2016 12:00:00 AM1/25/2017 12:00:00 AM1/25/2017 2:56 PM
DetailsLast Recertification DateUpdate 3/4/2015 12:00:00 AM2/12/2016 12:00:00 AM2/12/2016 12:02 PM
ContactsPrimary ContactUpdate CHAPMAN, PATRICK COO 6622248951-239CHAPMAN, PATRICK Program Administrator 6622248951-2393/4/2015 8:27 AM
DetailsLast Recertification DateUpdate 3/17/2014 12:00:00 AM3/4/2015 12:00:00 AM3/4/2015 8:27 AM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/17/2014 12:00:00 AM3/17/2014 3:59 AM
DetailsEntity SubnameUpdate BOONEVILLE COMMUNITY HEALTH CENTERBooneville Community Health Center3/17/2014 3:59 AM
AddressesBilling AddressInsert  NORTH BENTON COUNTY HEALTH CARE, INC. PO BOX 92 ASHLAND, MS 3860310/30/2013 1:31 PM
AddressesBilling AddressUpdate NORTH BENTON COUNTY HEALTH CARE, INC. PO BOX 92 ASHLAND, MS 38603NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC. PO BOX 92 ASHLAND, MS 3860310/30/2013 1:31 PM
ContactsAuthorizing OfficialInsert  NUNNALLY, JAMES D. CEO 6622248951-23010/30/2013 1:31 PM
DetailsEntity NameUpdate NORTH BENTON COUNTY HEALTH CARE, INC.NORTH MISSISSIPPI PRIMARY HEALTH CARE, INC.10/30/2013 1:31 PM
ContactsPrimary ContactInsert  CHAPMAN, PATRICK COO 6622248951-2393/18/2013 12:29 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM3/18/2013 12:28 PM
DetailsLast Recertification DateInsert   1/13/2006 6:49 AM
DetailsGrant NumberInsert  H80CS006351/13/2006 6:49 AM
Details340B IDInsert  CH04910C1/13/2006 6:49 AM
DetailsIs Authorizing Official EHB DataInsert   1/13/2006 6:49 AM
DatesLast Date That 340B Drugs PurchasedInsert   1/13/2006 6:49 AM
DetailsMedicare Provider NumberInsert   1/13/2006 6:49 AM
DetailsEntity NameInsert  NORTH BENTON COUNTY HEALTH CARE, INC.1/13/2006 6:49 AM
DetailsProgram CodeInsert  CH1/13/2006 6:49 AM
DetailsEntity SubnameInsert  BOONEVILLE COMMUNITY HEALTH CENTER1/13/2006 6:49 AM
DatesParticipating Approval DateInsert  1/13/2006 12:00:00 AM1/13/2006 6:49 AM
DetailsStateInsert  Active1/13/2006 6:49 AM
DatesRegistration DateInsert  1/12/2006 12:00:00 AM1/13/2006 6:49 AM
DatesSigned By DateInsert  12/30/2005 12:00:00 AM1/13/2006 6:49 AM
DatesStart DateInsert  4/1/2006 12:00:00 AM1/13/2006 6:49 AM
TerminationsTermination CommentsInsert   1/13/2006 6:49 AM
TerminationsTermination DateInsert   1/13/2006 6:49 AM
TerminationsTermination Effective DateInsert   1/13/2006 6:49 AM
TerminationsTermination ReasonInsert   1/13/2006 6:49 AM