Covered Entity Details

CH06011A JEFFERSON COMPREHENSIVE CARE SYSTEM, INC. (Active) - information as of 5/24/2025 12:40:29 AM

Main Details

Name

JEFFERSON COMPREHENSIVE CARE SYSTEM, INC.

Subdivision Name

COLLEGE STATION CLINIC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-004771

340B ID

CH06011A

Grant Number

H80CS00727

Additional Details

Current Program Status

Active

Registration Date

12/4/2006

Participating Start Date

1/1/2007

Participating Approval Date

12/4/2006

Last Recertification Date

3/7/2025

Contacts

Authorizing Official

Jefferson Comprehensive Care System, Inc
Sandra J. Brown, Chief Executive Officer
(870) 543-2300

Primary Contact

Jefferson Comprehensive Care System, Inc.
Chanda Evans-McField, Chief Financial Officer
(870) 543-2300

Addresses

Street Address

4206 FRAZIER PIKE
COLLEGE STATION, AR 72053

Billing Address

JEFFERSON COMPREHENSIVE CARE SYSTEM INC
PO BOX 1285
PINE BLUFF, AR 71613-1285

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?
Yes

State	Medicaid Number	NPI Number
AR	122642749,117778749	1932305737,1154386597

Shipping Addresses

Shipping Address 1

JEFFERSON COMPREHENSIVE CARE SYSTEM INC
1101 TENNESSEE STREET
PINE BLUFF, AR 71601

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
Contract Detail	DOCTORS ORDERS PHARMACY #4	WHITEHALL PHARMACY LLC	2701 E HARDING AVE	PINE BLUFF	AR	71601	10/12/2023	01/01/2024			01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH060110	Active	BPS-H80-002751	JEFFERSON COMPREHENSIVE CARE SYSTEM, INC.	JEFFERSON COMPREHENSIVE CARE SYSTEM, Inc.	1101 S Tennessee St	Pine Bluff	AR
CH06011A	Active	BPS-H80-004771	JEFFERSON COMPREHENSIVE CARE SYSTEM, INC.	COLLEGE STATION CLINIC	4206 FRAZIER PIKE	COLLEGE STATION	AR
CH06011B	Active	BPS-H80-001952	JEFFERSON COMPREHENSIVE CARE SYSTEM, INC.	ALTHEIMER CLINIC	309 S EDLINE	ALTHEIMER	AR
CH06011C	Active	BPS-H80-021297	JEFFERSON COMPREHENSIVE CARE SYSTEM, INC.	REDFIELD CLINIC 1	823 RIVER RD	REDFIELD	AR
CH06011D	Terminated	BPS-H80-002598	JEFFERSON COMPREHENSIVE CARE SYSTEM INC	RISON CENTER	505 SYCAMORE	RISON	AR
CH06011G	Active	BPS-H80-013992	JEFFERSON COMPREHENSIVE CARE SYSTEM INC	LITTLE ROCK CHC	1100 N. University Ave., Suite 125	LITTLE ROCK	AR
CH06011P	Active	BPS-H80-024978	JEFFERSON COMPREHENSIVE CARE SYSTEM INC	Homeless Open Hands	3000 Springer Blvd Ste. B	LITTLE ROCK	AR
CH06011Q	Active	BPS-H80-021154	JEFFERSON COMPREHENSIVE CARE SYSTEM, INC.	North Little Rock Community Health Center	2525 Willow St. Ste. 1	North Little Rock	AR
CH06011R	Active	BPS-H80-036405	JEFFERSON COMPREHENSIVE CARE SYSTEM INC	ARKANSAS BAPTIST COLLEGE CLINIC	1724 South Bishop Street	Little Rock	AR
CH06011S	Active	BPS-H80-037698	JEFFERSON COMPREHENSIVE CARE SYSTEM INC	Downtown Little Rock Community Health Center	1400 Main St	Little Rock	AR

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH060110	ALLCARE PHARMACY EXPRESS	3006 W 28TH AVE		PINE BLUFF	AR	71603	01/01/2019	12/31/2020
CH060110	ALLCARE SPECIALTY PHARMACY, LLC	10620 COLONEL GLENN RD STE 300		LITTLE ROCK	AR	72204-8048	10/01/2019
CH06011G	ALLCARE SPECIALTY PHARMACY, LLC	10620 COLONEL GLENN RD STE 300		LITTLE ROCK	AR	72204-8048	01/01/2024
CH060110	CITY PHARMACY	1801 BROADWAY ST		LITTLE ROCK	AR	72206-1222	04/01/2019
CH06011Q	CITY PHARMACY	1801 BROADWAY ST		LITTLE ROCK	AR	72206-1222	01/01/2024
CH060110	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	01/01/2014
CH060110	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	01/01/2014
CH060110	D&D PHARMACY LLC	8908 KANIS ROAD, SUITE 350		LITTLE ROCK	AR	72205	10/01/2019	01/01/2020
CH060110	DOCTOR'S ORDERS PHARMACY #2	DOCTOR'S ORDERS PHARMACY #2	2302 W 28TH AVE STE B	PINE BLUFF	AR	71603	04/01/2021
CH06011B	DOCTOR'S ORDERS PHARMACY #2	DOCTOR'S ORDERS PHARMACY #2	2302 W 28TH AVE STE B	PINE BLUFF	AR	71603	01/01/2024
CH060110	DOCTORS ORDERS PHARMACY #4	WHITEHALL PHARMACY LLC	2701 E HARDING AVE	PINE BLUFF	AR	71601	07/01/2023
CH06011A	DOCTORS ORDERS PHARMACY #4	WHITEHALL PHARMACY LLC	2701 E HARDING AVE	PINE BLUFF	AR	71601	01/01/2024
CH060110	KROGER PHARMACY #550	1100 EAST ROOSEVELT ROAD		LITTLE ROCK	AR	72206	07/01/2020
CH06011P	KROGER PHARMACY #550	1100 EAST ROOSEVELT ROAD		LITTLE ROCK	AR	72206	01/01/2024
CH060110	REDFIELD PHARMACY MANAGEMENT	DBA REDFIELD PHARMACY	1017 SHERIDAN RD	REDFIELD	AR	72132-9356	10/01/2020
CH060110	SCPG ARKANSAS LLC	DBA: EXPRESS RX OF PINE BLUFF	3006 W 28TH AVE	PINE BLUFF	AR	71603-4803	04/01/2021
CH06011C	SCPG ARKANSAS LLC	DBA: EXPRESS RX OF PINE BLUFF	3006 W 28TH AVE	PINE BLUFF	AR	71603-4803	01/01/2024
CH060110	SUPER 1 FOODS PHARMACY #622	2800 S. HAZEL STREET		PINE BLUFF	AR	71603	10/01/2019	12/31/2022
CH060110	SUPER 1 FOODS PHARMACY #628	5805 DOLLARWAY RD		PINE BLUFF	AR	71602	10/01/2019	12/31/2022
CH060110	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2019
CH060110	WAL-MART PHARMACY 10-0339	1123 HIGHWAY 79/167 BYPASS	PO BOX 705	FORDYCE	AR	71742	01/01/2019	01/01/2019
CH060110	WAL-MART PHARMACY 10-3331	5501 SOUTH OLIVE ST		PINE BLUFF	AR	71603	01/01/2019
CH06011R	WAL-MART PHARMACY 10-3331	5501 SOUTH OLIVE ST		PINE BLUFF	AR	71603	01/01/2024
CH060110	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2019
CH060110	WALGREEN CO.	DBA: WALGREENS # 03412	5917 BASELINE RD	LITTLE ROCK	AR	72209	10/01/2018
CH060110	WALGREEN CO.	WALGREENS #15361	2503 W 28TH AVE	PINE BLUFF	AR	71603	10/01/2018
CH060110	WALGREEN CO.	WALGREENS #21379	5905 DOLLARWAY RD	PINE BLUFF	AR	71602	10/01/2018
CH060110	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16545	1200 JOHN BARROW RD STE 102	LITTLE ROCK	AR	72205	10/01/2018
CH060110	WALGREEN CO.	DBA: WALGREENS # 03416	4823 JFK BLVD	NORTH LITTLE ROCK	AR	72116	10/01/2020
CH060110	WALGREEN CO.	DBA: WALGREENS # 05730	3710 S. UNIVERSITY AVE	LITTLE ROCK	AR	72204	10/01/2020
CH060110	WALGREEN CO.	DBA: WALGREENS # 05993	111 N BOWMAN RD	LITTLE ROCK	AR	72211	10/01/2020
CH060110	WALGREEN CO.	WALGREENS #15791	1601 MAIN STREET	LITTLE ROCK	AR	72206	10/01/2020
CH060110	WALGREEN CO.	DBA: WALGREENS # 10364	9200 N RODNEY PARHAM RD	LITTLE ROCK	AR	72227-6202	04/01/2022
CH060110	WALGREEN CO.	WALGREENS #21547	2800 S HAZEL ST STE B	PINE BLUFF	AR	71603	01/01/2024
CH060110	WALGREEN CO.	WALGREENS #21551	5805 DOLLARWAY RD STE B	WHITE HALL	AR	71602	01/01/2024
CH060110	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2022
CH060110	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH060110	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH060110	WARMACK PHARMACIES INC	D/B/A RISON PHARMACY	301 MAIN ST	RISON	AR	71665	10/01/2018	10/31/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/23/2024 10:11:47 AM	3/7/2025 10:22:54 AM	3/7/2025 10:22 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/13/2024 9:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		117778749	9/13/2024 9:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	9/13/2024 9:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1154386597	9/13/2024 9:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		AR	9/13/2024 9:36 AM
Details	Last Recertification Date	Update	Recertification	2/15/2023 3:45:08 PM	2/23/2024 10:11:47 AM	2/23/2024 10:11 AM
Details	Last Recertification Date	Update	Recertification	2/8/2022 11:22:57 AM	2/15/2023 3:45:08 PM	2/15/2023 3:45 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/25/2022 2:34 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		122642749	7/25/2022 2:34 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	7/25/2022 2:34 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1932305737	7/25/2022 2:34 PM
Medicaid Billing	NPI: State	Insert	Change Request		AR	7/25/2022 2:34 PM
Details	Last Recertification Date	Update	Recertification	2/22/2021 11:19:49 AM	2/8/2022 11:22:57 AM	2/8/2022 11:22 AM
Details	Last Recertification Date	Update	Recertification	2/19/2020 12:57:10 PM	2/22/2021 11:19:49 AM	2/22/2021 11:19 AM
Details	Last Recertification Date	Update	Recertification	1/30/2019 2:44:42 PM	2/19/2020 12:57:10 PM	2/19/2020 12:57 PM
Details	Last Recertification Date	Update	Recertification	2/23/2018 11:51:04 AM	1/30/2019 2:44:42 PM	1/30/2019 2:44 PM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/23/2018 11:51:04 AM	2/23/2018 11:51 AM
Contacts	Primary Contact	Update	Recertification	Evans-McField, Chanda Chief Financial Officer 8705432300	Evans-McField, Chanda Chief Financial Officer Jefferson Comprehensive Care System, Inc. 8705432300	2/23/2018 11:36 AM
Contacts	Authorizing Official	Update		Brown, Sandra J. Chief Executive Officer 8705432300	Brown, Sandra J. Chief Executive Officer Jefferson Comprehensive Care System, Inc 8705432300	10/10/2017 12:39 PM
Contacts	Authorizing Official	Insert			Brown, Sandra J. Chief Executive Officer 8705432300	1/26/2017 9:50 AM
Contacts	Primary Contact	Insert			Evans-McField, Chanda Chief Financial Officer 8705432300	1/26/2017 9:50 AM
Addresses	Main Address	Insert			4206 FRAZIER PIKE COLLEGE STATION, AR 72053	1/25/2017 12:04 PM
Details	Last Recertification Date	Update		3/3/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 12:03 PM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	3/3/2016 12:00:00 AM	3/3/2016 10:08 AM
Details	Last Recertification Date	Update		3/19/2014 12:00:00 AM	3/4/2015 12:00:00 AM	3/4/2015 11:47 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/19/2014 12:00:00 AM	3/19/2014 3:36 PM
Details	Entity Name	Update		JEFFERSON COMPREHENSIVE CARE SYSTEM INC	JEFFERSON COMPREHENSIVE CARE SYSTEM, INC.	3/19/2014 3:36 PM
Details	Entity Subname	Update		COLLEGE STATION CENTER	COLLEGE STATION CLINIC	3/19/2014 3:36 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/15/2013 11:01 AM
Addresses	Billing Address	Insert			JEFFERSON COMPREHENSIVE CARE SYSTEM INC PO BOX 1285 PINE BLUFF, AR 71613-1285	1/17/2013 3:03 PM
Addresses	Shipping Address	Insert			JEFFERSON COMPREHENSIVE CARE SYSTEM INC 1101 TENNESSEE STREET PINE BLUFF, AR 71601	12/6/2006 9:58 AM
Details	Last Recertification Date	Insert				12/6/2006 9:58 AM
Details	Grant Number	Insert			H80CS00727	12/6/2006 9:58 AM
Details	340B ID	Insert			CH06011A	12/6/2006 9:58 AM
Details	Is Authorizing Official EHB Data	Insert				12/6/2006 9:58 AM
Dates	Last Date That 340B Drugs Purchased	Insert				12/6/2006 9:58 AM
Details	Medicare Provider Number	Insert				12/6/2006 9:58 AM
Details	Entity Name	Insert			JEFFERSON COMPREHENSIVE CARE SYSTEM INC	12/6/2006 9:58 AM
Details	Program Code	Insert			CH	12/6/2006 9:58 AM
Details	Entity Subname	Insert			COLLEGE STATION CENTER	12/6/2006 9:58 AM
Dates	Participating Approval Date	Insert			12/4/2006 12:00:00 AM	12/6/2006 9:58 AM
Details	State	Insert			Active	12/6/2006 9:58 AM
Dates	Registration Date	Insert			12/4/2006 12:00:00 AM	12/6/2006 9:58 AM
Dates	Signed By Date	Insert			11/30/2006 12:00:00 AM	12/6/2006 9:58 AM
Dates	Start Date	Insert			1/1/2007 12:00:00 AM	12/6/2006 9:58 AM
Terminations	Termination Comments	Insert				12/6/2006 9:58 AM
Terminations	Termination Date	Insert				12/6/2006 9:58 AM
Terminations	Termination Effective Date	Insert				12/6/2006 9:58 AM
Terminations	Termination Reason	Insert				12/6/2006 9:58 AM

340B Drug Pricing Program Database