Covered Entity Details

CH04306C NORTHEAST MISSISSIPPI HEALTH CARE, INC. (Active) - information as of 5/3/2025 11:28:48 PM

Main Details

Name

NORTHEAST MISSISSIPPI HEALTH CARE, INC.

Subdivision Name

BYHALIA FAMILY DENTAL CLINIC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-009954

340B ID

CH04306C

Grant Number

H80CS00432

Additional Details

Current Program Status

Active

Registration Date

9/8/2011

Participating Start Date

10/1/2011

Participating Approval Date

9/25/2011

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Northeast Mississippi Health Care, Inc.
Clifton Rodgers, Physician
(662) 349-6220

Primary Contact

Northeast Mississippi Health Care, Inc.
Andrea Chrestman, COO/CCO
(662) 838-2163 Ext: 235

Addresses

Street Address

34 Brunswick Street
Byhalia, MS 38611-0698

Billing Address
Same as Street Address

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

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	FRED'S PHARMACY #2099	15 EAST STONEWALL RD		BYHALIA	MS	38611	03/13/2013	04/01/2013	11/30/2018	01/03/2020
Contract Detail	TYSON DRUGS INC	145 E VAN DORN AVE	P.O. BOX 10	HOLLY SPRINGS	MS	38635-3025	04/16/2018	07/01/2018		04/16/2018
Contract Detail	WAL-MART PHARMACY 10-0303	950 MACKIE DR		HOLLY SPRINGS	MS	38635	02/15/2023	04/01/2023		04/01/2023

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH043060	Active	BPS-H80-002409	NORTHEAST MISSISSIPPI HEALTH CARE, INC.	DBA BYHALIA FAMILY HEALTH CENTER	12 BRUNSWICK ST	BYHALIA	MS
CH04306A	Active	BPS-H80-000358	NORTHEAST MISSISSIPPI HEALTH CARE, INC.	MT. PLEASANT FAMILY HLTH CLINIC	154 OLD MT. PLEASANT ROAD	MOUNT PLEASANT	MS
CH04306C	Active	BPS-H80-009954	NORTHEAST MISSISSIPPI HEALTH CARE, INC.	BYHALIA FAMILY DENTAL CLINIC	34 Brunswick Street	Byhalia	MS
CH04306D	Active	BPS-H80-013741	NORTHEAST MISSISSIPPI HEALTH CARE, INC.	DeSoto Community Health Center	7535 Airways Boulevard	Southaven	MS

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH043060	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	01/01/2019	01/31/2025
CH043060	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019	01/31/2025
CH043060	BYHALIA DRUG COMPANY	2438 CHURCH STREET		BYHALIA	MS	38611	04/01/2017
CH043060	FRED'S PHARMACY #2099	15 EAST STONEWALL RD		BYHALIA	MS	38611	09/20/2011	11/13/2018
CH04306A	FRED'S PHARMACY #2099	15 EAST STONEWALL RD		BYHALIA	MS	38611	09/20/2011	11/30/2018
CH04306C	FRED'S PHARMACY #2099	15 EAST STONEWALL RD		BYHALIA	MS	38611	04/01/2013	11/30/2018
CH043060	FRED'S PHARMACY #3084	2110 GOODMAN ROAD EAST		SOUTHAVEN	MS	38672	04/01/2015	11/26/2018
CH043060	KROGER FOOD & PHARMACY #452	7427 GOODMAN RD		OLIVE BRANCH	MS	38654	07/01/2019
CH043060	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	01/01/2019	01/31/2025
CH043060	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	01/01/2019	01/31/2025
CH043060	THE PHARMACY AT DESOTO	7601 SOUTHCREST PKWY	WEST ENTRANCE SUITE 100	SOUTHAVEN	MS	38671-4739	07/01/2019
CH043060	TYSON DRUGS INC	145 E VAN DORN AVE	P.O. BOX 10	HOLLY SPRINGS	MS	38635-3025	07/01/2018
CH04306A	TYSON DRUGS INC	145 E VAN DORN AVE	P.O. BOX 10	HOLLY SPRINGS	MS	38635-3025	07/01/2018
CH04306C	TYSON DRUGS INC	145 E VAN DORN AVE	P.O. BOX 10	HOLLY SPRINGS	MS	38635-3025	07/01/2018
CH04306D	TYSON DRUGS INC	145 E VAN DORN AVE	P.O. BOX 10	HOLLY SPRINGS	MS	38635-3025	07/01/2018
CH043060	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2019
CH043060	WAL-MART PHARMACY 10-0155	5219 HWY 51 NORTH		SENATOBIA	MS	38668	07/01/2019
CH043060	WAL-MART PHARMACY 10-0303	950 MACKIE DR		HOLLY SPRINGS	MS	38635	01/01/2017
CH04306C	WAL-MART PHARMACY 10-0303	950 MACKIE DR		HOLLY SPRINGS	MS	38635	04/01/2023
CH043060	WAL-MART PHARMACY 10-0848	6811 SOUTHCREST PKWY.		SOUTHAVEN	MS	38671	07/01/2024
CH043060	WAL-MART PHARMACY 10-2846	7950 CRAFT GOODMAN FRONTAGE RD		OLIVE BRANCH	MS	38654	01/01/2017
CH043060	WAL-MART PHARMACY 10-3593	2401 GOODMAN ROAD		HORN LAKE	MS	38637	07/01/2019
CH04306D	WAL-MART PHARMACY 10-3593	2401 GOODMAN ROAD		HORN LAKE	MS	38637	04/01/2023
CH043060	WAL-MART PHARMACY 10-5419	2600 MCINGVALE ROAD		HERNANDO	MS	38632	07/01/2019
CH043060	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2019
CH043060	WALGREEN CO	DBA: WALGREENS #10517	7030 HACKS CROSS RD	OLIVE BRANCH	MS	38654-4471	07/01/2019
CH043060	WALGREEN CO	DBA: WALGREENS #11890	2996 CHURCH ROAD E	SOUTHAVEN	MS	38671	01/01/2022
CH043060	WALGREEN CO	DBA; WALGREENS #12308	5148 HWY 51 NORTH	SENATOBIA	MS	38668	01/01/2022
CH04306A	WALGREEN CO	DBA: WALGREENS #10517	7030 HACKS CROSS RD	OLIVE BRANCH	MS	38654-4471	04/01/2023
CH043060	WALGREEN CO.	DBA: WALGREENS # 03323	1501 GOODMAN RD WEST	HORN LAKE	MS	38637	07/01/2019	03/21/2023
CH043060	WALGREEN CO.	DBA: WALGREENS # 05396	1011 GOODMAN ROAD EAST	SOUTHAVEN	MS	38671	07/01/2019
CH043060	WALGREEN CO.	DBA: WALGREENS # 07130	6958 GOODMAN RD	OLIVE BRANCH	MS	38654	07/01/2019
CH043060	WALGREEN CO.	DBA: WALGREENS # 06754	4028 GOODMAN ROAD WEST	HORN LAKE	MS	38637	10/01/2020
CH043060	WALGREEN CO.	DBA: WALGREENS # 02775	4155 S 3RD ST	MEMPHIS	TN	38109	01/01/2022
CH043060	WALGREEN CO.	DBA: WALGREENS # 04455	35 STATELINE RD WEST	SOUTHAVEN	MS	38671	01/01/2022
CH043060	WALGREEN CO.	DBA: WALGREENS # 09013	1065 STATELINE RD W	SOUTHAVEN	MS	38671	01/01/2022
CH043060	WALGREEN CO.	DBA: WALGREENS # 06212	824 W POPLAR AVE	COLLIERVILLE	TN	38017-2569	01/01/2022
CH043060	WALGREEN CO.	DBA: WALGREENS # 03176	4154 ELVIS PRESLEY BLVD	MEMPHIS	TN	38116	01/01/2022
CH043060	WALGREEN CO.	DBA: WALGREENS # 07849	4991 HIGHWAY 51 NORTH	HORN LAKE	MS	38637-4101	01/01/2022
CH043060	WALGREEN CO.	DBA : WALGREENS #10706	950 E COMMERCE STREET	HERNANDO	MS	38632-2433	01/01/2022
CH043060	WALGREEN CO.	DBA: WALGREENS # 06858	5900 KNIGHT ARNOLD	MEMPHIS	TN	38115	01/01/2022	04/29/2025
CH043060	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2022
CH043060	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH043060	WALMART PHARMACY 10-6964	4150 GOODMAN ROAD WEST		HORN LAKE	MS	38637	07/01/2024
CH043060	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/31/2024 2:28:22 PM	2/10/2025 12:32:50 PM	2/10/2025 12:32 PM
Addresses	Main Address	Update	Change Request	34 East Brunswick Street Byhalia, MS 38611-0698	34 Brunswick Street Byhalia, MS 38611-0698	2/6/2024 5:18 PM
Details	Last Recertification Date	Update	Recertification	2/6/2023 2:23:23 PM	1/31/2024 2:28:22 PM	1/31/2024 2:28 PM
Details	Last Recertification Date	Update	Recertification	2/1/2022 8:56:52 AM	2/6/2023 2:23:23 PM	2/6/2023 2:23 PM
Details	Last Recertification Date	Update	Recertification	2/4/2021 9:11:41 AM	2/1/2022 8:56:52 AM	2/1/2022 8:56 AM
Details	Last Recertification Date	Update	Recertification	1/28/2020 8:51:38 AM	2/4/2021 9:11:41 AM	2/4/2021 9:11 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 9:40:45 AM	1/28/2020 8:51:38 AM	1/28/2020 8:51 AM
Details	Last Recertification Date	Update	Recertification	2/8/2018 10:48:09 AM	1/29/2019 9:40:45 AM	1/29/2019 9:40 AM
Contacts	Primary Contact	Update	Recertification	Rodgers, Clifton Physician Northeast Mississippi Health Care, Inc. 6623496220	Chrestman, Andrea COO/CCO Northeast Mississippi Health Care, Inc. 6628382163-235	2/8/2018 10:48 AM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/8/2018 10:48:09 AM	2/8/2018 10:48 AM
Contacts	Authorizing Official	Update		Rodgers, Clifton Physician 6623496220	Rodgers, Clifton Physician Northeast Mississippi Health Care, Inc. 6623496220	2/8/2018 10:33 AM
Contacts	Primary Contact	Update		Rodgers, Clifton Physician 6623496220	Rodgers, Clifton Physician Northeast Mississippi Health Care, Inc. 6623496220	2/8/2018 10:33 AM
Contacts	Authorizing Official	Insert			Rodgers, Clifton Physician 6623496220	5/11/2017 12:24 PM
Contacts	Primary Contact	Insert			Rodgers, Clifton Physician 6623496220	5/11/2017 12:24 PM
Addresses	Main Address	Insert			34 EAST BRUNSWICK STREET BYHALIA, MS 38611-0698	1/25/2017 9:49 AM
Contacts	Signed By	Insert			MCKINNEY, MARJORIE EXECUTIVE DIRECTOR 6628382163-214	1/25/2017 9:49 AM
Details	Last Recertification Date	Update		2/16/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 9:49 AM
Details	Last Recertification Date	Update		2/10/2015 12:00:00 AM	2/16/2016 12:00:00 AM	2/16/2016 12:15 PM
Details	Last Recertification Date	Update		3/16/2014 12:00:00 AM	2/10/2015 12:00:00 AM	2/10/2015 3:45 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/16/2014 12:00:00 AM	3/16/2014 4:10 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/28/2013 12:38 PM
Dates	Participating Approval Date	Update			9/25/2011 12:00:00 AM	9/25/2011 4:13 PM
Details	State	Update		Pending	Active	9/25/2011 4:13 PM
Dates	Start Date	Update			10/1/2011 12:00:00 AM	9/25/2011 4:13 PM
Details	340B ID	Update		ONLINE_REG	CH04306C	9/8/2011 11:03 AM
Details	Last Recertification Date	Insert				9/8/2011 10:45 AM
Details	Grant Number	Insert			H80CS00432	9/8/2011 10:45 AM
Details	340B ID	Insert			ONLINE_REG	9/8/2011 10:45 AM
Details	Is Authorizing Official EHB Data	Insert				9/8/2011 10:45 AM
Dates	Last Date That 340B Drugs Purchased	Insert				9/8/2011 10:45 AM
Details	Medicare Provider Number	Insert				9/8/2011 10:45 AM
Details	Entity Name	Insert			NORTHEAST MISSISSIPPI HEALTH CARE, INC.	9/8/2011 10:45 AM
Details	Program Code	Insert			CH	9/8/2011 10:45 AM
Details	Entity Subname	Insert			BYHALIA FAMILY DENTAL CLINIC	9/8/2011 10:45 AM
Dates	Participating Approval Date	Insert				9/8/2011 10:45 AM
Details	State	Insert			Pending	9/8/2011 10:45 AM
Dates	Registration Date	Insert			9/8/2011 12:00:00 AM	9/8/2011 10:45 AM
Dates	Signed By Date	Insert			9/8/2011 12:00:00 AM	9/8/2011 10:45 AM
Dates	Start Date	Insert				9/8/2011 10:45 AM
Terminations	Termination Comments	Insert				9/8/2011 10:45 AM
Terminations	Termination Date	Insert				9/8/2011 10:45 AM
Terminations	Termination Effective Date	Insert				9/8/2011 10:45 AM
Terminations	Termination Reason	Insert				9/8/2011 10:45 AM

340B Drug Pricing Program Database