Covered Entity Details

CAH251318-00 NORTH SUNFLOWER MEDICAL CENTER (Active) - information as of 5/6/2025 11:01:28 PM

Main Details

Name

NORTH SUNFLOWER MEDICAL CENTER

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH251318-00

Medicare Provider Number

251318

Additional Details

Current Program Status

Active

Registration Date

9/1/2010

Participating Start Date

9/16/2010

Participating Approval Date

9/2/2010

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

North Sunflower Medical Center
Sam Miller, Chief Executive Officer
(662) 721-0186

Primary Contact

North Sunflower Medical Center
Mike Gilbow, Pharmacy Director
(662) 756-4381

Addresses

Street Address

840 NORTH OAK AVENUE
RULEVILLE, MS 38771

Billing Address
Same as Street Address

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?
No

Shipping Addresses

Shipping Address 1

North Sunflower Medical Center (DBA) North Sunflower Medical Center Pharmacy
860 North Oak Avenue
Ruleville, MS 38771

Shipping Address 2

North Sunflower Medical Center (DBA) Haire Drug Center, LLC
805 1st street
Cleveland, MS 38732

Shipping Address 3

North Sunflower Medical Center (DBA) Sunflower Greenwood Pharmacy
201 West Park Avenue
Greenwood, MS 38930

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	COVENANT PHARMACY LLC		371A HIGHLAND COLONY PARKWAY	RIDGELAND	MS	39157	04/09/2014	07/01/2014	01/31/2016	05/15/2018
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/14/2025	07/01/2025		04/14/2025
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/14/2025	07/01/2025		04/14/2025
Contract Detail	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05801	212 W. PARK AVE.	GREENWOOD	MS	38930	04/14/2025	07/01/2025		04/14/2025
Contract Detail	NORTH SUNFLOWER MEDICAL CENTER	DBA NORTH SUNFLOWER MEDICAL CENTER PHARM	860 N OAK AVE	RULEVILLE	MS	38771	07/15/2015	10/01/2015	04/13/2021	04/13/2021
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	10/13/2022	01/01/2023		01/01/2023
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/13/2022	01/01/2023		01/01/2023
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	10/13/2022	01/01/2023		01/01/2023
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	10/13/2022	01/01/2023		01/01/2023
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/13/2022	01/01/2023		01/01/2023
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/13/2022	01/01/2023		01/01/2023
Contract Detail	SUNFLOWER DISCOUNT PHARMACY		840 NORTH OAK	RULEVILLE	MS	38771	03/14/2013	04/01/2013	09/30/2015	05/15/2018
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/15/2021	07/01/2021		07/01/2021
Contract Detail	WAL-MART PHARMACY 10-0716	2202 HWY 82 WEST		GREENWOOD	MS	38930	04/14/2025	07/01/2025		04/14/2025
Contract Detail	WAL-MART PHARMACY 10-1530	710 N DAVIS AVENUE		CLEVELAND	MS	38732	04/15/2021	07/01/2021		07/01/2021
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/11/2021	01/01/2022		01/01/2022
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/15/2021	07/01/2021		07/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09896	301 N DAVIS AVE	CLEVELAND	MS	38732-2349	04/15/2021	07/01/2021		07/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11171	700 W PARK AVE	GREENWOOD	MS	38930-2910	04/15/2021	07/01/2021		07/01/2021
Contract Detail	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	04/07/2025	07/01/2025		04/07/2025
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/12/2023	07/01/2023		07/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/10/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH251318-01	Child	CAH	NORTH SUNFLOWER MEDICAL CENTER	SUNFLOWER RURAL HEALTH CLINIC	840 NORTH OAK AVENUE	RULEVILLE	MS	Active
CAH251318-02	Child	CAH	NORTH SUNFLOWER MEDICAL CENTER	North Sunflower Pulmonary Clinic - Pulmonary	820 North Oak Avenue	Ruleville	MS	Active
CAH251318-03	Child	CAH	NORTH SUNFLOWER MEDICAL CENTER	North Sunflower Cardiac Clinic - Cardiac	628 Everett & Elisha Langdon Street	Ruleville	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Insert	Change Request		North Sunflower Medical Center (DBA) Sunflower Greenwood Pharmacy 201 West Park Avenue Greenwood, MS 38930	9/13/2024 8:35 AM
Contacts	Primary Contact	Update	Recertification	Clark, Rodney COO North Sunflower Medical Center 6627562711	Gilbow, Mike Pharmacy Director North Sunflower Medical Center 6627564381	8/15/2024 7:01 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 3:42:44 PM	8/15/2024 7:01:28 AM	8/15/2024 7:01 AM
Details	Last Recertification Date	Update	Recertification	8/25/2022 1:05:48 PM	8/16/2023 3:42:44 PM	8/16/2023 3:42 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 9:03:50 AM	8/25/2022 1:05:48 PM	8/25/2022 1:05 PM
Details	Last Recertification Date	Update	Recertification	8/17/2020 3:19:32 PM	8/16/2021 9:03:50 AM	8/16/2021 9:03 AM
Addresses	Shipping Address	Insert	Change Request		North Sunflower Medical Center (DBA) North Sunflower Medical Center Pharmacy 860 North Oak Avenue Ruleville, MS 38771	9/15/2020 6:54 AM
Addresses	Shipping Address	Insert	Change Request		North Sunflower Medical Center (DBA) Haire Drug Center, LLC 805 1st street Cleveland, MS 38732	9/15/2020 6:54 AM
Addresses	Shipping Address	Delete	Change Request	North Sunflower Medical Center 805 1st Street Cleveland, MS 38732		9/14/2020 6:28 AM
Details	Last Recertification Date	Update	Recertification	8/19/2019 10:15:06 AM	8/17/2020 3:19:32 PM	8/17/2020 3:19 PM
Addresses	Shipping Address	Insert	Change Request		North Sunflower Medical Center 805 1st Street Cleveland, MS 38732	6/30/2020 7:53 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 2:57:16 PM	8/19/2019 10:15:06 AM	8/19/2019 10:15 AM
Details	Last Recertification Date	Update	Recertification	11/20/2017 2:35:52 PM	8/21/2018 2:57:16 PM	8/21/2018 2:57 PM
Addresses	Main Address	Update	Change Request	840 NORTH OAK RULEVILLE, MS 38771	840 NORTH OAK AVENUE RULEVILLE, MS 38771	5/17/2018 8:50 AM
Contacts	Primary Contact	Insert	Recertification		Clark, Rodney COO North Sunflower Medical Center 6627562711	11/20/2017 2:35 PM
Details	Last Recertification Date	Update	Recertification	8/12/2016 12:00:00 AM	11/20/2017 2:35:52 PM	11/20/2017 2:35 PM
Contacts	Authorizing Official	Update	Profile Change Request	Miller, Sam Operations Consultant North Sunflower Medical Center 6627210186	Miller, Sam Chief Executive Officer North Sunflower Medical Center 6627210186	10/5/2017 12:09 PM
Contacts	Authorizing Official	Update		Miller, Sam Operations Consultant 6627210186	Miller, Sam Operations Consultant North Sunflower Medical Center 6627210186	10/2/2017 10:39 AM
Contacts	Authorizing Official	Insert			Miller, Sam Operations Consultant 6627210186	8/12/2016 3:22 PM
Addresses	Main Address	Insert			840 NORTH OAK RULEVILLE, MS 38771	8/12/2016 9:59 AM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/12/2016 12:00:00 AM	8/12/2016 9:59 AM
Details	Last Recertification Date	Update		9/5/2014 12:00:00 AM	8/10/2015 12:00:00 AM	8/10/2015 12:27 PM
Details	Last Recertification Date	Update		9/6/2013 2:19:12 PM	9/5/2014 12:00:00 AM	9/5/2014 8:53 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/6/2013 2:19:12 PM	9/6/2013 2:19 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/8/2012 10:51 AM
Details	Last Recertification Date	Insert				9/16/2010 12:58 PM
Details	Grant Number	Insert				9/16/2010 12:58 PM
Details	340B ID	Insert			CAH251318-00	9/16/2010 12:58 PM
Details	Is Authorizing Official EHB Data	Insert				9/16/2010 12:58 PM
Dates	Last Date That 340B Drugs Purchased	Insert				9/16/2010 12:58 PM
Details	Medicare Provider Number	Insert			251318	9/16/2010 12:58 PM
Details	Entity Name	Insert			NORTH SUNFLOWER MEDICAL CENTER	9/16/2010 12:58 PM
Details	Program Code	Insert			CAH	9/16/2010 12:58 PM
Details	Entity Subname	Insert				9/16/2010 12:58 PM
Dates	Participating Approval Date	Insert			9/2/2010 12:00:00 AM	9/16/2010 12:58 PM
Details	State	Insert			Active	9/16/2010 12:58 PM
Dates	Registration Date	Insert			9/1/2010 12:00:00 AM	9/16/2010 12:58 PM
Dates	Signed By Date	Insert			9/1/2010 12:00:00 AM	9/16/2010 12:58 PM
Dates	Start Date	Insert			9/16/2010 12:00:00 AM	9/16/2010 12:58 PM
Terminations	Termination Comments	Insert				9/16/2010 12:58 PM
Terminations	Termination Date	Insert				9/16/2010 12:58 PM
Terminations	Termination Effective Date	Insert				9/16/2010 12:58 PM
Terminations	Termination Reason	Insert				9/16/2010 12:58 PM