Covered Entity Details

CH04577P Southeast Mississippi Rural Health Initiative, Inc. (Active) - information as of 4/28/2025 1:42:54 AM

Main Details

Name

Southeast Mississippi Rural Health Initiative, Inc.

Subdivision Name

Picayune Family Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-003301

340B ID

CH04577P

Grant Number

H80CS00610

Additional Details

Current Program Status

Active

Registration Date

7/8/2010

Participating Start Date

10/1/2010

Participating Approval Date

7/8/2010

Last Recertification Date

2/14/2025

Contacts

Authorizing Official

SeMRHI
Janice Robinson, CEO
(601) 545-3700

Primary Contact

Southeast Mississippi Rural Health Initiative, Inc.
Charnay Ingram, Director of Pharmacy, PharmD
(601) 544-4163 Ext: 3902

Addresses

Street Address

1911 Read Rd
Picayune, MS 39466-2730

Billing Address

SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
PO BOX 1729
HATTIESBURG, MS 39403-1729

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

Comments

Comment	Last Updated On
2/16/11 ADDED BILL-TO ADD	02/16/2011

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	07250059	1003013764

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
Contract Detail	MEDICAL CENTER PHARMACY	141 KIRKWOOD ST		PICAYUNE	MS	39466-3946	11/15/2010	11/15/2010			03/28/2013

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH045770	Active	BPS-H80-000890	Southeast Mississippi Rural Health Initiative, Inc.	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	5488 U S Highway 49	Hattiesburg	MS
CH04577A	Active	BPS-H80-001021	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	SUMRALL FAMILY HEALTH CENTER	1016 HIGHWAY 42	SUMRALL	MS
CH04577AA	Active	BPS-H80-036072	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Sumrall High School	184 Center Avenue	Sumrall	MS
CH04577AB	Active	BPS-H80-035507	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Sumrall Elementary School	198 Todd Rd	Sumrall	MS
CH04577AC	Active	BPS-H80-035222	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Sumrall Middle School	1217 Highway 42	Sumrall	MS
CH04577AD	Active	BPS-H80-035217	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Lamar County School Clinic	424 Martin Luther King Dr	Purvis	MS
CH04577AE	Active	BPS-H80-035220	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Lumberton Elementary School	16 ADA Bounds Lane	Lumberton	MS
CH04577AF	Active	BPS-H80-035221	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Baxterville School	1201 Bilbo Rd	Lumberton	MS
CH04577AG	Active	BPS-H80-035226	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Oak Grove High School	5198 Old Highway 11	Hattiesburg	MS
CH04577AH	Active	BPS-H80-035215	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Purvis Lower Elementary School	5976 US Highway 11	Purvis	MS
CH04577AJ	Active	BPS-H80-035223	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Purvis Middle School	213 School St	Purvis	MS
CH04577AK	Active	BPS-H80-035508	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Purvis Upper Elementary School	310 Mitchell Ave	Purvis	MS
CH04577AL	Active	BPS-H80-035225	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Oak Grove Elementary	70 Leaf Ln	Hattiesburg	MS
CH04577AM	Active	BPS-H80-035219	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Purvis High School	220 School St	Purvis	MS
CH04577AN	Active	BPS-H80-035216	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Lumberton High School	7920 U S Highway 11	Lumberton	MS
CH04577AP	Active	BPS-H80-035509	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Oak Grove Middle School	2543 Old Highway 24	Hattiesburg	MS
CH04577AQ	Active	BPS-H80-035506	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Oak Grove Longleaf	5279 W 4th St	Hattiesburg	MS
CH04577AR	Active	BPS-H80-035224	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Bellevue Elementary	1760 Old Highway 24	Hattiesburg	MS
CH04577B	Active	BPS-H80-003486	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	SEMINARY FAMILY HEALTH CENTER	100 HIGHWAY 535	SEMINARY	MS
CH04577C	Active	BPS-H80-004056	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	NEW AUGUSTA FAMILY HEALTH CENTER	404 MAIN STREET	NEW AUGUSTA	MS
CH04577D	Active	BPS-H80-002839	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	BROOKLYN FAMILY HEALTH CTR	44 BROOKLYN-JANICE ROAD	BROOKLYN	MS
CH04577E	Active	BPS-H80-000781	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	BEAUMONT FAMILY HEALTH CENTER	1411 BRADLEY AVENUE	BEAUMONT	MS
CH04577F	Active	BPS-H80-005128	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	LUMBERTON FAMILY HEALTH CENTER	598 WEST 11TH AVENUE	LUMBERTON	MS
CH04577G	Active	BPS-H80-003976	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	HATTIESBURG FAMILY HEALTH CENTER	66 Old AIRPORT ROAD	HATTIESBURG	MS
CH04577M	Active	BPS-H80-004360	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	WOMEN'S HEALTH CENTER	62 OLD AIRPORT ROAD	HATTIESBURG	MS
CH04577N	Active	BPS-H80-001157	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	HATTIESBURG PUBLIC SCHOOL AND COMMUNITY CLINIC	404 LILLIE BURNEY STREET	HATTIESBURG	MS
CH04577P	Active	BPS-H80-003301	Southeast Mississippi Rural Health Initiative, Inc.	Picayune Family Health Center	1911 Read Rd	Picayune	MS
CH04577Q	Active	BPS-H80-013968	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Petal School Clinic	36 PANTHER STADIUM DR	PETAL	MS
CH04577R	Active	BPS-H80-005122	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	HATTIESBURG High School & COMMUNITY CLIN.	605 Stadium Dr	Hattiesburg	MS
CH04577S	Active	BPS-H80-021856	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Minor Care Clinic	123 S 27th Ave	Hattiesburg	MS
CH04577T	Active	BPS-H80-005970	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	HATTIESBURG HIGH SCHOOL CAMPUS CLINIC	301 Hutchinson Ave	Hattiesburg	MS
CH04577U	Active	BPS-H80-000754	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	HATTIESBURG COMMUNITY DENTAL CTR	68 Airport Rd	Hattiesburg	MS
CH04577V	Active	BPS-H80-014208	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	N.R. Burger School and Community Clinic	180 WSF TATUM DRIVE EXT	HATTIESBURG	MS
CH04577W	Active	BPS-H80-017936	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	SeMRHI Support Services Center	64 Old Airport Road	Hattiesburg	MS
CH04577X	Terminated	BPS-H80-019214	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Collins High School	1208 S Dogwood Ave	Collins	MS
CH04577Y	Active	BPS-H80-007297	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	GRACE CHRISTIAN ELEM SCHOOL	2207 W 7th St	Hattiesburg	MS
CH04577Z	Active	BPS-H80-037574	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	SeMRHI Mobile Unit	72 Old Airport Rd	Hattiesburg	MS

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH045770	30A INNOVATIONS,LLC	FREEDOM PHARMACY	3902 HARDY STREET	HATTIESBURG	MS	39402	01/01/2021
CH045770	ABITACARE LLC	D/B/A VITAL CARE RX	1501 23RD AVE SUITE B	MERIDIAN	MS	39301	07/01/2019
CH045770	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	10/01/2018
CH045770	AVITA PHARMACY 1028	340B PARTNERS PHARMACY-DALLAS LLC DBA AV	750 FORT WORTH AVE STE H100	DALLAS	TX	75208-1811	07/01/2013
CH045770	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	01/01/2013
CH045770	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	07/01/2013
CH045770	C&C DRUGS, INC	C&C DRUGS, INC	204 MAIN ST PO BOX 327	COLLINS	MS	39428	10/01/2014
CH045770	CALEB'S HOMETOWN PHARMACY	801 MAIN ST		COLLINS	MS	39428	04/01/2016
CH045770	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	04/01/2025
CH045770	CENTERWELL PHARMACY, INC.	11010 FLORIDA CROWN DRIVE, SUITE 200		ORLANDO	FL	32824	04/01/2025
CH045770	CITY REXALL DRUGS	349 S MAIN ST		PICAYUNE	MS	39466-4415	04/01/2025
CH045770	FAIRVIEW DISCOUNT PHARMACY	500 KATIE AVENUE		HATTIESBURG	MS	39401	07/01/2017	07/02/2018
CH045770	JOHN'S DISCOUNT DRUGS	410 W MAIN AVE		LUMBERTON	MS	39455-2437	10/01/2017
CH045770	K & B MISSISSIPPI CORPORATION	RITE AID #7219	5916 US HIGHWAY 49	HATTIESBURG	MS	39401	09/06/2012	01/16/2018
CH045770	K & B MISSISSIPPI CORPORATION	RITE AID #7221	100 HIGHWAY 42	PETAL	MS	39465	09/06/2012	01/16/2018
CH045770	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05473	2103 GAUSE BLVD E	SLIDELL	LA	70461	10/01/2019
CH045770	LOUISIANA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05330	1305 GAUSE BLVD.	SLIDELL	LA	70458	10/01/2019
CH045770	LOUISIANA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 7192	800 BROWNSWITCH RD.	SLIDELL	LA	70458	10/01/2019
CH045770	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	10/01/2018
CH045770	MEDICAL CENTER PHARMACY	141 KIRKWOOD ST		PICAYUNE	MS	39466-3946	04/01/2011
CH04577P	MEDICAL CENTER PHARMACY	141 KIRKWOOD ST		PICAYUNE	MS	39466-3946	11/15/2010
CH045770	MISSISSIPPI CVS PHARMACY, L.L.C.	CVS PHARMACY # 17144	6143 U S HIGHWAY 98 STE 80	HATTIESBURG	MS	39402	10/01/2019
CH045770	MISSISSIPPI CVS PHARMACY, L.L.C.	CVS/PHARMACY #8993	365 COLE ROAD	HATTIESBURG	MS	39402	10/01/2019
CH045770	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05777	501 NORTH 16TH AVE.	LAUREL	MS	39440	10/01/2019
CH045770	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05744	3910 HARDY ST	HATTIESBURG	MS	39402	10/01/2019
CH045770	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05740	1701 A HWY 43 N	PICAYUNE	MS	39466	10/01/2019
CH045770	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3124	2507 HARDY ST.	HATTIESBURG	MS	39401	10/01/2019
CH045770	PEARL RIVER DRUG COMPANY	510 S MAIN ST		POPLARVILLE	MS	39470	04/01/2011	07/13/2015
CH04577F	PEARL RIVER DRUG COMPANY	510 S MAIN ST		POPLARVILLE	MS	39470	11/15/2010	07/13/2015
CH045770	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	10/01/2018
CH045770	POMANK VENTURES	DBA FAIRVIEW PHARMACY AND COMPOUNDING	500 KATIE AVE	HATTIESBURG	MS	39401	07/10/2018
CH045770	SEMINARY DRUGS	TAYLORSVILLE DRUGS, DBA	300 PINE STREET PO BOX 1397	TAYLORSVILLE	MS	39168	04/01/2015
CH045770	STRICKLAND'S CASH & SAVE	DISCOUNT PHARMACY INC	703 N FRONT ST PO BOX 1619	RICHTON	MS	39476	07/26/2012
CH045770	SUMRALL DRUG STORE	1109 MS HWY 42		SUMRALL	MS	39482	04/01/2011
CH04577A	SUMRALL DRUG STORE	1109 MS HWY 42		SUMRALL	MS	39482	12/06/2010
CH045770	VITAL CARE OF MERIDIAN	1501 23RD AVE		MERIDIAN	MS	39301	10/01/2016
CH045770	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2019
CH045770	WAL-MART PHARMACY 10-0887	36 BYRD BLVD		PETAL	MS	39465	01/01/2019
CH045770	WAL-MART PHARMACY 10-0916	6072 U.S. HWY. 98		HATTIESBURG	MS	39402	01/01/2019
CH045770	WAL-MART PHARMACY 10-0970	235 FRONTAGE RD		PICAYUNE	MS	39466	01/01/2019
CH045770	WAL-MART PHARMACY 10-1168	1001 HWY 98 BYPASS		COLUMBIA	MS	39429	01/01/2019
CH045770	WAL-MART PHARMACY 10-2717	5901 HWY. 49 SOUTH		HATTIESBURG	MS	39401	01/01/2019
CH045770	WAL-MART PHARMACY 10-3528	1053 FRONTAGE DRIVE EAST		WIGGINS	MS	39577	01/01/2019
CH045770	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2019
CH045770	WALGREEN CO	DBA: WALGREENS #12929	804 SPRING STREET	WAYNESBORO	MS	39367	10/01/2013
CH045770	WALGREEN CO	DBA: WALGREENS #10805	1628 SIMPSON HWY 49	MAGEE	MS	39111-5000	07/01/2017
CH045770	WALGREEN CO.	DBA: WALGREENS # 05307	6130 U.S. HIGHWAY 49	HATTIESBURG	MS	39401	10/01/2013
CH045770	WALGREEN CO.	DBA: WALGREENS # 07579	5093 HARDY STREET	HATTIESBURG	MS	39402-1336	10/01/2013
CH045770	WALGREEN CO.	DBA: WALGREENS # 10273	2209 HIGHWAY 11 NORTH	PICAYUNE	MS	39466-2065	10/01/2013
CH045770	WALGREEN CO.	DBA: WALGREENS # 10290	1505 HIGHWAY 43 S	PICAYUNE	MS	39466-9297	10/01/2013
CH045770	WALGREEN CO.	DBA: WALGREENS # 10430	103 WEST CENTRAL AVE	PETAL	MS	39465-2313	10/01/2013
CH045770	WALGREEN CO.	DBA: WALGREENS #13609	1028 HIGHWAY 98 BYPASS	COLUMBIA	MS	39429	10/01/2013
CH045770	WALGREEN CO.	DBA: WALGREENS # 09037	419 N 16TH AVE	LAUREL	MS	39440-3850	07/01/2017
CH045770	WALGREEN CO.	RITE AID #07221	100 HWY 42	PETAL	MS	39465	04/04/2018	03/28/2018
CH045770	WALGREEN CO.	ELLISVILLE DRUG #15828, POWERED BY WALGR	915 HILL STREET	ELLISVILLE	MS	39437	07/01/2019
CH045770	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21286	4500 OLD PASS RD	GULFPORT	MS	39501	07/01/2023
CH045770	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2025
CH045770	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2013	06/25/2015
CH045770	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH045770	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH045770	WINN DIXIE PHARMACY #1334	2800 LINCOLN ROAD		HATTIESBURG	MS	39402	01/01/2019	09/04/2020
CH045770	WINN DIXIE PHARMACY#2626	4400 HARDY ST		HATTIESBURG	MS	39402-1372	12/16/2020	11/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/6/2024 9:48:53 AM	2/14/2025 4:02:56 PM	2/14/2025 4:02 PM
Contacts	Authorizing Official	Update	Group Change Request	EUBANKS, POLLY CFO Southeast Mississippi Rural Health Initiative, Inc. 6015458700	Robinson, Janice CEO SeMRHI 6015453700	8/12/2024 6:53 PM
Details	Last Recertification Date	Update	Recertification	2/8/2023 4:33:06 PM	2/6/2024 9:48:53 AM	2/6/2024 9:48 AM
Details	Last Recertification Date	Update	Recertification	2/3/2022 8:27:16 AM	2/8/2023 4:33:06 PM	2/8/2023 4:33 PM
Details	Last Recertification Date	Update	Recertification	2/5/2021 12:55:24 PM	2/3/2022 8:27:16 AM	2/3/2022 8:27 AM
Contacts	Authorizing Official	Update	AO Change Request	DYSE, GEROLDEAN CEO Southeast Mississippi Rural Health Initiative, Inc. 6015458700	EUBANKS, POLLY CFO Southeast Mississippi Rural Health Initiative, Inc. 6015458700	2/2/2022 3:25 PM
Contacts	Primary Contact	Update	OPA Edit	EUBANKS, POLLY CFO Southeast Mississippi Rural Health Initiative, Inc. 6015458700	Ingram, Charnay Director of Pharmacy, PharmD Southeast Mississippi Rural Health Initiative, Inc. 6015444163-3902	2/2/2022 1:40 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1003013764 ( )		2/5/2021 12:55 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1003013764	2/5/2021 12:55 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	2/5/2021 12:55 PM
Details	Last Recertification Date	Update	Recertification	1/27/2020 3:57:08 PM	2/5/2021 12:55:24 PM	2/5/2021 12:55 PM
Details	Last Recertification Date	Update	Recertification	2/12/2019 12:21:28 PM	1/27/2020 3:57:08 PM	1/27/2020 3:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/8/2020 4:27 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		07250059	1/8/2020 4:27 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	1/8/2020 4:27 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1003013764	1/8/2020 4:27 PM
Details	Last Recertification Date	Update	Recertification	2/8/2018 6:16:28 PM	2/12/2019 12:21:28 PM	2/12/2019 12:21 PM
Contacts	Primary Contact	Update	Profile Change Request	EUBANDS, POLLY CFO Southeast Mississippi Rural Health Initiative, Inc. 6015458700	EUBANKS, POLLY CFO Southeast Mississippi Rural Health Initiative, Inc. 6015458700	1/22/2019 12:15 PM
Details	Last Recertification Date	Update	Recertification	2/1/2017 12:00:00 AM	2/8/2018 6:16:28 PM	2/8/2018 6:16 PM
Contacts	Authorizing Official	Update		DYSE, GEROLDEAN CEO 6015458700	DYSE, GEROLDEAN CEO Southeast Mississippi Rural Health Initiative, Inc. 6015458700	1/16/2018 10:07 AM
Contacts	Primary Contact	Update		EUBANDS, POLLY CFO 6015458700	EUBANDS, POLLY CFO Southeast Mississippi Rural Health Initiative, Inc. 6015458700	1/8/2018 11:56 AM
Contacts	Authorizing Official	Insert			DYSE, GEROLDEAN CEO 6015458700	7/13/2017 2:06 PM
Addresses	Main Address	Insert			1911 Read Rd Picayune, MS 39466-2730	2/1/2017 2:30 PM
Contacts	Primary Contact	Update		POOLE, MICAH CFO 6015458700	EUBANDS, POLLY CFO 6015458700	2/1/2017 2:30 PM
Details	Last Recertification Date	Update		2/12/2016 12:00:00 AM	2/1/2017 12:00:00 AM	2/1/2017 2:30 PM
Details	Last Recertification Date	Update		1/28/2015 12:00:00 AM	2/12/2016 12:00:00 AM	2/12/2016 9:45 AM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	1/28/2015 12:00:00 AM	1/28/2015 10:11 AM
Details	Entity Name	Update		SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	Southeast Mississippi Rural Health Initiative, Inc.	3/31/2014 4:25 PM
Details	Entity Subname	Update		PICAYUNE FAMILY HEALTH CENTER	Picayune Family Health Center	3/31/2014 4:25 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/10/2014 12:00:00 AM	2/10/2014 7:34 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/26/2013 10:02 AM
Addresses	Billing Address	Insert			SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. PO BOX 1729 HATTIESBURG, MS 39403-1729	8/24/2011 7:59 AM
Contacts	Primary Contact	Insert			POOLE, MICAH CFO 6015458700	2/16/2011 3:45 PM
Details	Last Recertification Date	Insert				2/16/2011 3:45 PM
Details	Grant Number	Insert			H80CS00610	2/16/2011 3:45 PM
Details	340B ID	Insert			CH04577P	2/16/2011 3:45 PM
Details	Is Authorizing Official EHB Data	Insert				2/16/2011 3:45 PM
Dates	Last Date That 340B Drugs Purchased	Insert				2/16/2011 3:45 PM
Details	Medicare Provider Number	Insert				2/16/2011 3:45 PM
Details	Entity Name	Insert			SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.	2/16/2011 3:45 PM
Details	Program Code	Insert			CH	2/16/2011 3:45 PM
Details	Entity Subname	Insert			PICAYUNE FAMILY HEALTH CENTER	2/16/2011 3:45 PM
Dates	Participating Approval Date	Insert			7/8/2010 12:00:00 AM	2/16/2011 3:45 PM
Details	State	Insert			Active	2/16/2011 3:45 PM
Dates	Registration Date	Insert			7/8/2010 12:00:00 AM	2/16/2011 3:45 PM
Dates	Signed By Date	Insert			6/28/2010 12:00:00 AM	2/16/2011 3:45 PM
Dates	Start Date	Insert			10/1/2010 12:00:00 AM	2/16/2011 3:45 PM
Terminations	Termination Comments	Insert				2/16/2011 3:45 PM
Terminations	Termination Date	Insert				2/16/2011 3:45 PM
Terminations	Termination Effective Date	Insert				2/16/2011 3:45 PM
Terminations	Termination Reason	Insert				2/16/2011 3:45 PM
Details	Comments Public	Insert			2/16/11 ADDED BILL-TO ADD	2/16/2011 3:45 PM

340B Drug Pricing Program Database