Covered Entity Details

CAH251307-03 NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL (Active) - information as of 5/4/2025 10:20:00 PM

Main Details

Name

NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL

Subdivision Name

BROOKSVILLE MEDICAL CLINIC

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH251307-03

Medicare Provider Number

251307

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

9/30/2010

Participating Start Date

9/30/2010

Participating Approval Date

9/30/2010

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

Noxubee General Critical Access Hospital
Meg Ebert, CEO
(662) 726-4231 Ext: 316

Primary Contact

Noxubee General Critical Access Hospital
Joshua Drew Holdiness, 340b Coordinator
(662) 788-4346

Addresses

Street Address

1560 N. OLIVER ST.
BROOKSVILLE, MS 39739

Billing Address

NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL
P.O. BOX 480
MACON, MS 39341

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	09014825	1669657565

Shipping Addresses

Shipping Address 1

Macon Primary Pharmacy
34 Hospital Rd
Macon, MS 39341

Shipping Address 2

Brooksville Pharmacy
1556 North Oliver Street
Brooksville, MS 39739

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
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH251307-01	Child	CAH	NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL	MACON PRIMARY CARE CLINIC	78 HOSPITAL RD	MACON	MS	Active
CAH251307-02	Child	CAH	NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL	MACON MEDICAL CLINIC	3878 JEFFERSON ST	MACON	MS	Active
CAH251307-03	Child	CAH	NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL	BROOKSVILLE MEDICAL CLINIC	1560 N. OLIVER ST.	BROOKSVILLE	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/8/2023 1:42:41 PM	9/4/2024 3:32:04 PM	9/4/2024 3:32 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 9:13:08 AM	9/8/2023 1:42:41 PM	9/8/2023 1:42 PM
Details	Last Recertification Date	Update	Recertification	8/26/2021 3:54:56 PM	9/8/2022 9:13:08 AM	9/8/2022 9:13 AM
Addresses	Shipping Address	Insert	Group Change Request		Brooksville Pharmacy 1556 North Oliver Street Brooksville, MS 39739	9/7/2021 1:16 PM
Details	Last Recertification Date	Update	Recertification	8/28/2020 10:05:39 AM	8/26/2021 3:54:56 PM	8/26/2021 3:54 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669657565	8/28/2020 10:05 AM
Medicaid Billing	NPI: State	Insert	Recertification		MS	8/28/2020 10:05 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1669657565 ( )		8/28/2020 10:05 AM
Details	Last Recertification Date	Update	Recertification	8/28/2019 10:20:04 AM	8/28/2020 10:05:39 AM	8/28/2020 10:05 AM
Contacts	Authorizing Official	Update	Change Request	MCKAY, DANNY ADMINISTRATOR Noxubee General Critical Access Hospital 6627264231-337	Ebert, Meg CEO Noxubee General Critical Access Hospital 6627264231-316	8/7/2020 10:50 AM
Details	Last Recertification Date	Update	Recertification	9/7/2018 11:30:43 AM	8/28/2019 10:20:04 AM	8/28/2019 10:20 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 11:38:08 AM	9/7/2018 11:30:43 AM	9/7/2018 11:30 AM
Addresses	Shipping Address	Insert	Change Request		Macon Primary Pharmacy 34 Hospital Rd Macon, MS 39341	7/5/2018 12:28 PM
Addresses	Main Address	Update	Recertification	139 N. OLIVER ST. BROOKSVILLE, MS 39739	1560 N. OLIVER ST. BROOKSVILLE, MS 39739	11/29/2017 11:38 AM
Details	Last Recertification Date	Update	Recertification	9/6/2016 12:00:00 AM	11/29/2017 11:38:08 AM	11/29/2017 11:38 AM
Contacts	Primary Contact	Update	Change Request	MCKAY, DANNY ADMINISTRATOR 6627264231-337	Holdiness, Joshua Drew 340b Coordinator Noxubee General Critical Access Hospital 6627884346	10/16/2017 3:26 PM
Contacts	Authorizing Official	Update		MCKAY, DANNY ADMINISTRATOR 6627264231-337	MCKAY, DANNY ADMINISTRATOR Noxubee General Critical Access Hospital 6627264231-337	10/6/2017 4:35 PM
Addresses	Main Address	Insert			139 N. OLIVER ST. BROOKSVILLE, MS 39739	9/6/2016 12:39 PM
Contacts	Authorizing Official	Update		MCKAY, DANNY ADMINISTRATOR 6627264231-337	MCKAY, DANNY ADMINISTRATOR 6627264231-337	9/6/2016 12:39 PM
Contacts	Primary Contact	Update		WEST, EMMA RN	MCKAY, DANNY ADMINISTRATOR 6627264231-337	9/6/2016 12:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/6/2016 12:39 PM
Medicaid Billing	Medicaid: Number	Insert			09014825	9/6/2016 12:39 PM
Medicaid Billing	Medicaid: State	Insert			MS	9/6/2016 12:39 PM
Medicaid Billing	NPI: Number	Insert			1669657565	9/6/2016 12:39 PM
Details	Last Recertification Date	Update		9/4/2015 12:00:00 AM	9/6/2016 12:00:00 AM	9/6/2016 12:39 PM
Details	Last Recertification Date	Update		8/25/2014 12:00:00 AM	9/4/2015 12:00:00 AM	9/4/2015 3:40 PM
Details	Last Recertification Date	Update		8/21/2013 10:13:01 AM	8/25/2014 12:00:00 AM	8/25/2014 5:01 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/21/2013 10:13:01 AM	8/21/2013 10:13 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/1/2012 7:44 AM
Addresses	Billing Address	Insert			NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL P.O. BOX 480 MACON, MS 39341	9/30/2010 12:35 PM
Contacts	Primary Contact	Insert			WEST, EMMA RN	9/30/2010 12:35 PM
Contacts	Authorizing Official	Insert			MCKAY, DANNY ADMINISTRATOR 6627264231-337	9/30/2010 12:35 PM
Details	Last Recertification Date	Insert				9/30/2010 12:35 PM
Details	Grant Number	Insert				9/30/2010 12:35 PM
Details	340B ID	Insert			CAH251307-03	9/30/2010 12:35 PM
Details	Is Authorizing Official EHB Data	Insert				9/30/2010 12:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert				9/30/2010 12:35 PM
Details	Medicare Provider Number	Insert			251307	9/30/2010 12:35 PM
Details	Entity Name	Insert			NOXUBEE GENERAL CRITICAL ACCESS HOSPITAL	9/30/2010 12:35 PM
Details	Program Code	Insert			CAH	9/30/2010 12:35 PM
Details	Entity Subname	Insert			BROOKSVILLE MEDICAL CLINIC	9/30/2010 12:35 PM
Dates	Participating Approval Date	Insert			9/30/2010 12:00:00 AM	9/30/2010 12:35 PM
Details	State	Insert			Active	9/30/2010 12:35 PM
Dates	Registration Date	Insert			9/30/2010 12:00:00 AM	9/30/2010 12:35 PM
Dates	Signed By Date	Insert			9/21/2010 12:00:00 AM	9/30/2010 12:35 PM
Dates	Start Date	Insert			9/30/2010 12:00:00 AM	9/30/2010 12:35 PM
Terminations	Termination Comments	Insert				9/30/2010 12:35 PM
Terminations	Termination Date	Insert				9/30/2010 12:35 PM
Terminations	Termination Effective Date	Insert				9/30/2010 12:35 PM
Terminations	Termination Reason	Insert				9/30/2010 12:35 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Parent/Child

History