Covered Entity Details

CAH251325-00 COVINGTON COUNTY HOSPITAL (Active) - information as of 6/2/2025 8:29:51 AM

Main Details

Name

COVINGTON COUNTY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH251325-00

Medicare Provider Number

251325

Additional Details

Current Program Status

Active

Registration Date

8/11/2010

Participating Start Date

8/18/2010

Participating Approval Date

8/11/2010

Last Recertification Date

9/9/2024

Contacts

Authorizing Official

Covington County Hospital
Gregg Gibbes, CEO
(601) 765-6711

Primary Contact

Covington County Hospital
JENNIFER PATTERSON, DIRECTOR OF PHARMACY
(601) 698-0109

Addresses

Street Address

701 SOUTH HOLLY STREET
COLLINS, MS 39428

Billing Address

COVINGTON COUNTY HOSPITAL
P.O. BOX 1149
COLLINS, MS 39428

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	00020133	1215965249

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	C&C DRUGS, INC	C&C DRUGS, INC	204 MAIN ST PO BOX 327	COLLINS	MS	39428	10/11/2013	01/01/2014		10/11/2013
Contract Detail	CALEB'S HOMETOWN PHARMACY	801 MAIN ST		COLLINS	MS	39428	07/05/2017	10/01/2017	12/19/2018	01/14/2019
Contract Detail	CALEB'S HOMETOWN PHARMACY	801 MAIN ST		COLLINS	MS	39428	01/15/2021	04/01/2021		04/01/2021
Contract Detail	CLAYTON PHARMACY	301 HOSPITAL BOULEVARD		COLLINS	MS	39428	10/11/2013	01/01/2014	06/01/2020	01/15/2021
Contract Detail	CRANFORDS DRUG STORE INC	CRANFORDS DRUG STORE	P.O. BOX 130 121 W. MAIN ST	SEMINARY	MS	39479	10/11/2013	01/01/2014		10/11/2013
Contract Detail	FRED'S PHARMACY #1279	1211 S. FIR AVENUE	PO BOX 2542	COLLINS	MS	39428	10/15/2014	01/01/2015		10/15/2014
Contract Detail	GENE POLK'S PHARMACY	406 SIMPSON HIGHWAY 149	GENE POLK'S, INC.	MAGEE	MS	39111-3416	10/13/2017	01/01/2018		10/13/2017
Contract Detail	POWELL DRUG STORE	ATTN: POWELL, BILL	519 S MAIN ST	MOUNT OLIVE	MS	39119-8901	10/11/2013	01/01/2014		10/11/2013
Contract Detail	SCPG MISSISSIPPI LLC	DBA: EXPRESS RX OF SEMINARY	121 W MAIN ST	SEMINARY	MS	39479-9028	01/15/2021	04/01/2021		04/01/2021
Contract Detail	SEMINARY DRUGS	TAYLORSVILLE DRUGS, DBA	300 PINE STREET PO BOX 1397	TAYLORSVILLE	MS	39168	10/14/2014	01/01/2015	01/27/2016	03/02/2018
Contract Detail	SERVICE REXALL DRUGS	3069 SIMPSON HIGHWAY 13		MENDENHALL	MS	39114-3077	01/15/2021	04/01/2021		04/01/2021
Contract Detail	SOUTH CENTRAL SPECIALTY PHARMACY	1220 JEFFERSON ST		LAUREL	MS	39440	10/16/2023	01/01/2024		01/01/2024
Contract Detail	STEPHEN L LA FRANCE PHARMACY INC.	DBA: ELLISVILLE DRUG #15828	POWERED BY WALGREENS 915 HILL STREET	ELLISVILLE	MS	39437	10/10/2017	01/01/2018		10/10/2017
Contract Detail	SUMRALL DRUG STORE	1109 MS HWY 42		SUMRALL	MS	39482	01/15/2021	04/01/2021		04/01/2021
Contract Detail	TAYLORSVILLE DRUGS	TAYLORSVILLE DRUGS	300 PINE ST PO BOX 1397	TAYLORSVILLE	MS	39168	01/15/2021	04/01/2021		04/01/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/13/2017	01/01/2018		10/13/2017
Contract Detail	WAL-MART PHARMACY 10-1025	1608 VETERANS BLVD		MCCOMB	MS	39648	10/13/2017	01/01/2018	07/02/2018	07/18/2018
Contract Detail	WAL-MART PHARMACY 10-1192	1625 SIMPSON HIGHWAY #49		MAGEE	MS	39111	10/14/2014	01/01/2015	10/21/2015	11/09/2015
Contract Detail	WAL-MART PHARMACY 10-1192	1625 SIMPSON HIGHWAY #49		MAGEE	MS	39111	10/17/2016	01/01/2017		10/17/2016
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/13/2017	01/01/2018		10/13/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #10805	1628 SIMPSON HWY 49	MAGEE	MS	39111-5000	10/10/2017	01/01/2018		10/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05307	6130 U.S. HIGHWAY 49	HATTIESBURG	MS	39401	10/10/2017	01/01/2018		10/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07579	5093 HARDY STREET	HATTIESBURG	MS	39402-1336	10/10/2017	01/01/2018		10/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09037	419 N 16TH AVE	LAUREL	MS	39440-3850	10/10/2017	01/01/2018		10/10/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 10430	103 WEST CENTRAL AVE	PETAL	MS	39465-2313	10/10/2017	01/01/2018		10/10/2017
Contract Detail	WALGREEN CO.	ELLISVILLE DRUG #15828, POWERED BY WALGR	915 HILL STREET	ELLISVILLE	MS	39437	07/15/2019	10/01/2019		10/01/2019
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/16/2023	01/01/2024		01/01/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/16/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH251325-01	Child	CAH	COVINGTON COUNTY HOSPITAL	Green Tree Family Medical Clinic	603 S Main St	Mt Olive	MS	Active
CAH251325-02	Child	CAH	COVINGTON COUNTY HOSPITAL	Family Care Seminary	104 West Main Suite 20	Seminary	MS	Active
CAH251325-03	Child	CAH	COVINGTON COUNTY HOSPITAL	Family Care Main Street	210 Main Street	Collins	MS	Terminated
CAH251325-04	Child	CAH	COVINGTON COUNTY HOSPITAL	Family Care Express	3275 Hwy 49 North, Suite E	Collins	MS	Active
CAH251325-05	Child	CAH	COVINGTON COUNTY HOSPITAL	CCH Clinic Family Medical	301 Hospital Blvd.	Collins	MS	Active
CAH251325-06	Child	CAH	COVINGTON COUNTY HOSPITAL	COVINGTON COUNTY HOSPITAL - Medical Center of Magee	800 3RD ST SW	MAGEE	MS	Active
CAH251325-07	Child	CAH	COVINGTON COUNTY HOSPITAL	COVINGTON COUNTY HOSPITAL - Rural Health Clinic	1039 HIGHWAY 42 STE 3	SUMRALL	MS	Active
CAH251325-08	Child	CAH	COVINGTON COUNTY HOSPITAL	CCH Clinic Taylorsville	105 EATON ST	TAYLORSVILLE	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Change Request	07884766 09015963 09013978 06577892 00572251 08920207 02423709 00020133 (MS)		9/11/2024 12:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/11/2024 12:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00020133	9/11/2024 12:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	9/11/2024 12:39 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1013205350 (MS)		9/11/2024 12:39 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1598769044 (MS)		9/11/2024 12:39 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1336447861 (MS)		9/11/2024 12:39 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134435498 (MS)		9/11/2024 12:39 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1750895611 (MS)		9/11/2024 12:39 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1659995538 (MS)		9/11/2024 12:39 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1306460282 (MS)		9/11/2024 12:39 PM
Details	Last Recertification Date	Update	Recertification	8/23/2023 2:09:46 PM	9/9/2024 7:59:06 AM	9/9/2024 7:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/25/2023 3:30 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		07884766 09015963 09013978 06577892 00572251 08920207 02423709 00020133	10/25/2023 3:30 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	10/25/2023 3:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1013205350	10/25/2023 3:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	10/25/2023 3:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1598769044	10/25/2023 3:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	10/25/2023 3:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336447861	10/25/2023 3:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	10/25/2023 3:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1134435498	10/25/2023 3:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	10/25/2023 3:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1750895611	10/25/2023 3:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	10/25/2023 3:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1659995538	10/25/2023 3:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	10/25/2023 3:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1306460282	10/25/2023 3:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	10/25/2023 3:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1215965249	10/25/2023 3:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	10/25/2023 3:30 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 10:29:47 AM	8/23/2023 2:09:46 PM	8/23/2023 2:09 PM
Details	Last Recertification Date	Update	Recertification	8/20/2021 4:18:45 PM	8/30/2022 10:29:47 AM	8/30/2022 10:29 AM
Details	Last Recertification Date	Update	Recertification	9/4/2020 10:23:05 AM	8/20/2021 4:18:45 PM	8/20/2021 4:18 PM
Details	Last Recertification Date	Update	Recertification	8/29/2019 1:55:30 PM	9/4/2020 10:23:05 AM	9/4/2020 10:23 AM
Details	Last Recertification Date	Update	Recertification	8/31/2018 7:47:34 AM	8/29/2019 1:55:30 PM	8/29/2019 1:55 PM
Details	Last Recertification Date	Update	Recertification	11/8/2017 3:14:14 PM	8/31/2018 7:47:34 AM	8/31/2018 7:47 AM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/8/2017 3:14:14 PM	11/8/2017 3:14 PM
Contacts	Primary Contact	Update	Recertification	PATTERSON, JENNIFER DIRECTOR OF PHARMACY 6016980109	PATTERSON, JENNIFER DIRECTOR OF PHARMACY Covington County Hospital 6016980109	11/8/2017 3:10 PM
Contacts	Authorizing Official	Update		Gibbes, Gregg CEO 6017656711	Gibbes, Gregg CEO Covington County Hospital 6017656711	10/10/2017 11:48 AM
Contacts	Authorizing Official	Update		White III, S.L. CEO 6017656711	Gibbes, Gregg CEO 6017656711	7/5/2017 5:05 PM
Addresses	Main Address	Insert			701 SOUTH HOLLY STREET COLLINS, MS 39428	9/1/2016 5:31 PM
Contacts	Primary Contact	Update		PATTERSON, JENNIFER DIRECTOR OF PHARMACY 6016980109	PATTERSON, JENNIFER DIRECTOR OF PHARMACY 6016980109	9/1/2016 5:31 PM
Details	Last Recertification Date	Update		9/2/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 5:31 PM
Addresses	Billing Address	Insert			COVINGTON COUNTY HOSPITAL P.O. BOX 1149 COLLINS, MS 39428	8/22/2016 1:41 PM
Contacts	Authorizing Official	Update		EVANS, KIRSTIE CFO 6017656711	White III, S.L. CEO 6017656711	11/9/2015 7:29 PM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	9/2/2015 12:00:00 AM	9/2/2015 1:07 PM
Details	Last Recertification Date	Update		8/21/2013 10:07:32 AM	8/6/2014 12:00:00 AM	8/6/2014 12:14 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/21/2013 10:07:32 AM	8/21/2013 10:07 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/29/2012 10:03 AM
Contacts	Primary Contact	Insert			PATTERSON, JENNIFER DIRECTOR OF PHARMACY 6016980109	8/18/2010 2:35 PM
Contacts	Authorizing Official	Insert			EVANS, KIRSTIE CFO 6017656711	8/18/2010 2:35 PM
Details	Last Recertification Date	Insert				8/18/2010 2:35 PM
Details	Grant Number	Insert				8/18/2010 2:35 PM
Details	340B ID	Insert			CAH251325-00	8/18/2010 2:35 PM
Details	Is Authorizing Official EHB Data	Insert				8/18/2010 2:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/18/2010 2:35 PM
Details	Medicare Provider Number	Insert			251325	8/18/2010 2:35 PM
Details	Entity Name	Insert			COVINGTON COUNTY HOSPITAL	8/18/2010 2:35 PM
Details	Program Code	Insert			CAH	8/18/2010 2:35 PM
Details	Entity Subname	Insert				8/18/2010 2:35 PM
Dates	Participating Approval Date	Insert			8/11/2010 12:00:00 AM	8/18/2010 2:35 PM
Details	State	Insert			Active	8/18/2010 2:35 PM
Dates	Registration Date	Insert			8/11/2010 12:00:00 AM	8/18/2010 2:35 PM
Dates	Signed By Date	Insert			8/11/2010 12:00:00 AM	8/18/2010 2:35 PM
Dates	Start Date	Insert			8/18/2010 12:00:00 AM	8/18/2010 2:35 PM
Terminations	Termination Comments	Insert				8/18/2010 2:35 PM
Terminations	Termination Date	Insert				8/18/2010 2:35 PM
Terminations	Termination Effective Date	Insert				8/18/2010 2:35 PM
Terminations	Termination Reason	Insert				8/18/2010 2:35 PM