| Details | Nature of Support: Support Received To Date | Update | Recertification | 1/31/2026 12:00:00 AM | 2/28/2026 12:00:00 AM | 5/16/2025 5:02 PM |
| Details | Last Recertification Date | Update | Recertification | 5/6/2024 4:33:57 PM | 5/16/2025 5:02:27 PM | 5/16/2025 5:02 PM |
| Contacts | Primary Contact | Update | Group Change Request | Prince, Valerie
Director of Administration / CFO
Cobb & Douglas Public Health
7705142354 | Kemp, Jonathan
Director of Administration
Cobb & Douglas Public Health
7705143117 | 2/4/2025 7:43 AM |
| Contacts | Primary Contact | Update | Group Change Request | Sherrill, Craig
Director of Pharmacy
Cobb & Douglas Public Health
7705142350 | Prince, Valerie
Director of Administration / CFO
Cobb & Douglas Public Health
7705142354 | 7/15/2024 12:18 PM |
| Details | Last Recertification Date | Update | Recertification | 5/16/2023 7:52:51 AM | 5/6/2024 4:33:57 PM | 5/6/2024 4:33 PM |
| Details | Nature of Support: Support Received To Date | Update | Group Change Request | 12/31/2023 12:00:00 AM | 1/31/2026 12:00:00 AM | 2/7/2024 12:43 PM |
| Addresses | Billing Address | Update | Group Change Request | Georgia Department of Public Health Office of Pharmacy
200 Piedmont Ave SE
West Tower,
1502
Atlanta, GA 30334 | Georgia Department of Public Health, Office of Pharmacy
200 Piedmont Ave SE
West Tower
1508C
Atlanta, GA 30334 | 6/15/2023 10:28 AM |
| Addresses | Billing Address | Update | Recertification | Georgia Department of Public Health Office of Pharmacy
2 Peachtree St
9-420
Atlanta, GA 30303 | Georgia Department of Public Health Office of Pharmacy
200 Piedmont Ave SE
West Tower,
1502
Atlanta, GA 30334 | 5/16/2023 7:52 AM |
| Details | Last Recertification Date | Update | Recertification | 5/19/2022 4:46:02 PM | 5/16/2023 7:52:51 AM | 5/16/2023 7:52 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Terry, Latasha
STD Director
Georgia Department of Public Health Office of STD
4046574226 | Terry, Latasha
STD Director
Georgia Department of Public Health Office of STD
6786445464 | 5/14/2023 11:53 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1760563845 | 10/14/2022 1:37 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | GA | 10/14/2022 1:37 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1972572642 | 10/14/2022 1:37 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | GA | 10/14/2022 1:37 PM |
| Contacts | Primary Contact | Update | Group Change Request | Moon, Selina Gore
RPH
Cobb & Douglas Public Health
7705142345 | Sherrill, Craig
Director of Pharmacy
Cobb & Douglas Public Health
7705142350 | 9/29/2022 12:34 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 7/21/2022 8:23 AM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 003266690A | 7/21/2022 8:23 AM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 7/21/2022 8:23 AM |
| Details | Last Recertification Date | Update | Recertification | 5/19/2021 9:13:51 AM | 5/19/2022 4:46:02 PM | 5/19/2022 4:46 PM |
| Details | Nature of Support: Support Received From Date | Update | Recertification | | 1/1/2019 12:00:00 AM | 5/19/2021 9:13 AM |
| Details | Nature of Support: Support Received To Date | Update | Recertification | | 12/31/2023 12:00:00 AM | 5/19/2021 9:13 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1487878575 ( ) | | 5/19/2021 9:13 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1487878575 | 5/19/2021 9:13 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | GA | 5/19/2021 9:13 AM |
| Details | Last Recertification Date | Update | Recertification | 5/8/2020 11:16:09 AM | 5/19/2021 9:13:51 AM | 5/19/2021 9:13 AM |
| Details | NOFO Number | Update | Recertification | | PS19-1901 | 5/19/2021 9:13 AM |
| Details | Last Recertification Date | Update | Recertification | 6/3/2019 8:10:18 AM | 5/8/2020 11:16:09 AM | 5/8/2020 11:16 AM |
| Details | Grant Number | Update | Recertification | 6NH25PS005184-01-01 | NH25PS005184 | 5/8/2020 11:16 AM |
| Addresses | Billing Address | Update | Change Request | Georgia Department of Public Health Office of Pharmacy
2 Peachtree St
9th Floor
Atlanta, GA 30303 | Georgia Department of Public Health Office of Pharmacy
2 Peachtree St
9-420
Atlanta, GA 30303 | 1/9/2020 1:03 PM |
| Addresses | Shipping Address | Delete | Change Request | COBB-DOUGLAS PUBLIC HEALTH DISTRICT
1650 County Services Parkway
Marietta, GA 30008 | | 12/18/2019 12:36 PM |
| Addresses | Shipping Address | Insert | Change Request | | GEORGIA PUBLIC HEALTH DISTRICT 3-1
1650 County Services Parkway
Marietta, GA 30008 | 12/18/2019 12:36 PM |
| Details | Entity Name | Update | Change Request | GEORGIA DEPT OF PUBLIC HEALTH | COBB COUNTY BOARD OF HEALTH | 12/18/2019 12:36 PM |
| Addresses | Shipping Address | Delete | Change Request | Cobb Co Board of Health
1650 County Services Parkway
Marietta, GA 30008 | | 11/8/2019 9:09 AM |
| Addresses | Shipping Address | Insert | Change Request | | COBB-DOUGLAS PUBLIC HEALTH DISTRICT
1650 County Services Parkway
Marietta, GA 30008 | 11/8/2019 9:09 AM |
| Addresses | Shipping Address | Insert | Change Request | | Cobb Co Board of Health
1650 County Services Parkway
Marietta, GA 30008 | 9/24/2019 2:23 PM |
| Addresses | Main Address | Update | Change Request |
COBB COUNTY BOARD OF HEALTH
1650 COUNTY SERVICES PARKWAY
MARIETTA, GA 30008 |
1650 County Services Parkway
Marietta, GA 30008 | 9/23/2019 7:34 AM |
| Details | Last Recertification Date | Update | Recertification | 5/16/2018 6:46:07 AM | 6/3/2019 8:10:18 AM | 6/3/2019 8:10 AM |
| Details | Grant Number | Update | Recertification | 5NH25PS004329-05-00 | 6NH25PS005184-01-01 | 6/3/2019 8:10 AM |
| Details | Entity Subname | Update | Recertification | Marietta Community Health Center DISTRICT 3 - 1 | Marietta Community Health Center DISTRICT 3-1 | 6/3/2019 8:10 AM |
| Details | Nature Of Support | Delete | Recertification | In-Kind products or services (see note below; must have been purchased with section 318 funds) ()-() | | 5/16/2018 6:46 AM |
| Contacts | Primary Contact | Update | Recertification | MCGHEE, JEFF
PHARMACIST
DPH
7705142350 | Moon, Selina Gore
RPH
Cobb & Douglas Public Health
7705142345 | 5/16/2018 6:46 AM |
| Details | Last Recertification Date | Update | Recertification | 5/17/2017 12:00:00 AM | 5/16/2018 6:46:07 AM | 5/16/2018 6:46 AM |
| Details | Grant Number | Update | Recertification | 5NH25PS004329-04-00 | 5NH25PS004329-05-00 | 5/16/2018 6:46 AM |
| Details | Entity Subname | Update | Recertification | Marietta Community Health Center DISTRICT 3 - 1 | Marietta Community Health Center DISTRICT 3 - 1 | 5/16/2018 6:46 AM |
| Contacts | Authorizing Official | Update | Change Request | ALLEN, MICHELLE
Maternal and Child Health Director
Georgia Department of Public Health STD
4044632579 | Terry, Latasha
STD Director
Georgia Department of Public Health Office of STD
4046574226 | 1/12/2018 10:26 AM |
| Contacts | Primary Contact | Update | Change Request | MCGHEE, JEFF
PHARMACIST
7705142350 | MCGHEE, JEFF
PHARMACIST
DPH
7705142350 | 1/11/2018 9:33 AM |
| Contacts | Authorizing Official | Update | | ALLEN, MICHELLE
Maternal and Child Health Director
4044632579 | ALLEN, MICHELLE
Maternal and Child Health Director
Georgia Department of Public Health STD
4044632579 | 10/12/2017 3:19 PM |
| Contacts | Authorizing Official | Insert | | | ALLEN, MICHELLE
Maternal and Child Health Director
4044632579 | 8/1/2017 2:13 PM |
| Contacts | Primary Contact | Update | | MCGEE, JEFF
PHARMACIST
7705142350 | MCGHEE, JEFF
PHARMACIST
7705142350 | 5/18/2017 9:31 AM |
| Addresses | Main Address | Insert | | |
COBB COUNTY BOARD OF HEALTH
1650 COUNTY SERVICES PARKWAY
MARIETTA, GA 30008 | 5/17/2017 12:05 PM |
| Details | Last Recertification Date | Update | | 3/2/2016 12:00:00 AM | 5/17/2017 12:00:00 AM | 5/17/2017 12:05 PM |
| Details | Grant Number | Update | | 5H25PS004329-02 | 5NH25PS004329-04-00 | 5/17/2017 12:05 PM |
| Details | Entity Subname | Update | | DISTRICT 3 - 1 | Marietta Community Health Center DISTRICT 3 - 1 | 5/17/2017 12:05 PM |
| Details | Last Recertification Date | Update | | 3/2/2015 12:00:00 AM | 3/2/2016 12:00:00 AM | 3/2/2016 10:13 AM |
| Details | Grant Number | Update | | STD-GA | 5H25PS004329-02 | 3/2/2016 10:13 AM |
| Addresses | Billing Address | Insert | | | Georgia Department of Public Health Office of Pharmacy
2 Peachtree St
9th Floor
Atlanta, GA 30303 | 1/20/2016 2:06 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1487878575 | 1/20/2016 2:06 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 11/12/2015 2:10 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 000058616A | 11/12/2015 2:10 PM |
| Medicaid Billing | Medicaid: State | Insert | | | GA | 11/12/2015 2:10 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 3/2/2015 7:35 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 000456431C | 3/2/2015 7:35 AM |
| Medicaid Billing | Medicaid: State | Insert | | | GA | 3/2/2015 7:35 AM |
| Details | Nature Of Support | Insert | | | Direct Funding (dollars received from CDC or an intermediate organization) | 3/2/2015 7:35 AM |
| Details | Nature Of Support | Insert | | | In-Kind products or services (see note below; must have been purchased with section 318 funds) | 3/2/2015 7:35 AM |
| Details | Last Recertification Date | Update | | 2/25/2014 12:00:00 AM | 3/2/2015 12:00:00 AM | 3/2/2015 7:35 AM |
| Contacts | Primary Contact | Insert | | | MCGEE, JEFF
PHARMACIST
7705142350 | 1/15/2015 4:29 PM |
| Details | Last Recertification Date | Update | | 1/1/2012 12:00:00 AM | 2/25/2014 12:00:00 AM | 2/25/2014 6:28 AM |
| Details | Entity Name | Update | | GEORGIA DEPT OF COMMUNITY HEALTH | GEORGIA DEPT OF PUBLIC HEALTH | 1/22/2014 3:23 PM |
| Details | Entity Subname | Update | | DHR DISTR 3 UNIT 1 | DISTRICT 3 - 1 | 1/22/2014 3:23 PM |
| Details | Last Recertification Date | Update | | 1/1/2011 12:00:00 AM | 1/1/2012 12:00:00 AM | 11/30/2011 12:12 PM |
| Details | Last Recertification Date | Insert | | | 1/1/2011 12:00:00 AM | 11/8/2010 11:07 AM |
| Details | Grant Number | Insert | | | STD-GA | 11/8/2010 11:07 AM |
| Details | 340B ID | Insert | | | STD300600 | 11/8/2010 11:07 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 11/8/2010 11:07 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 11/8/2010 11:07 AM |
| Details | Medicare Provider Number | Insert | | | | 11/8/2010 11:07 AM |
| Details | Entity Name | Insert | | | GEORGIA DEPT OF COMMUNITY HEALTH | 11/8/2010 11:07 AM |
| Details | Program Code | Insert | | | STD | 11/8/2010 11:07 AM |
| Details | Entity Subname | Insert | | | DHR DISTR 3 UNIT 1 | 11/8/2010 11:07 AM |
| Dates | Participating Approval Date | Insert | | | 11/23/2004 12:00:00 AM | 11/8/2010 11:07 AM |
| Details | State | Insert | | | Active | 11/8/2010 11:07 AM |
| Dates | Registration Date | Insert | | | 1/1/1997 12:00:00 AM | 11/8/2010 11:07 AM |
| Dates | Signed By Date | Insert | | | 1/1/2011 12:00:00 AM | 11/8/2010 11:07 AM |
| Dates | Start Date | Insert | | | 1/1/1997 12:00:00 AM | 11/8/2010 11:07 AM |
| Terminations | Termination Comments | Insert | | | | 11/8/2010 11:07 AM |
| Terminations | Termination Date | Insert | | | | 11/8/2010 11:07 AM |
| Terminations | Termination Effective Date | Insert | | | | 11/8/2010 11:07 AM |
| Terminations | Termination Reason | Insert | | | | 11/8/2010 11:07 AM |
| Details | Comments Public | Insert | | | 11/20/09 UPDATED ENTITY NAME (WAS GEORGIA DEPT OF HUMAN RESOURCES); 11/23/04 UPDATED ADDR(WAS 1650 COUNTY SERVICES PARK MARIETTA GA 30060) | 11/8/2010 11:07 AM |