Covered Entity Details

CH04076M G.A. CARMICHAEL FAMILY HEALTH CENTER, INC. (Terminated) - information as of 6/12/2025 5:04:41 AM

Main Details

Name

G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.

Subdivision Name

HAYDEN STREET SATELLITE CLINIC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-002245

340B ID

CH04076M

Grant Number

H80CS00484

Additional Details

Current Program Status

Terminated

Registration Date

7/2/2013

Participating Start Date

10/1/2013

Participating Approval Date

9/13/2013

Last Recertification Date

2/3/2021

Termination Date
Termination Reason

4/1/2022
Other

Contacts

Authorizing Official

G. A. Carmichael Family Health Center, Inc.
James L. Coleman Jr., CEO
(601) 859-5213 Ext: 2291

Primary Contact

G.A. Carmichael Family Health Center, Inc.
Joshua Knox, Chief Programs Officer
(601) 953-2188

Addresses

Street Address

116 N Hayden St
Belzoni, MS 39038-3932

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	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH040760	Active	BPS-H80-002494	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	G. A. CARMICHAEL FAMILY HEALTH CENTER	1668 W Peace St	Canton	MS
CH04076A	Active	BPS-H80-000101	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	G.A. CARMICHAEL FAMILY HLTH CTR	1547 Jerry Clower Blvd	Yazoo City	MS
CH04076B	Terminated	BPS-H80-011447	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	Webster Elementary School	622 E Fourth St	Yazoo City	MS
CH04076C	Active	BPS-H80-007483	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	MCCOY ELEMENTARY SCHOOL	1835 School Dr	Yazoo City	MS
CH04076D	Active	BPS-H80-007369	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	WOOLFOLK ELEM SCHOOL CLINIC	215 E Fifth St	Yazoo City	MS
CH04076E	Active	BPS-H80-024488	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	MCNEAL ELEMENTARY SCHOOL CLINIC	364 Martin Luther King Dr	Canton	MS
CH04076F	Active	BPS-H80-007164	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	YAZOO COUNTY HIGH SCHOOL	6789 HIGHWAY 49 FRON	YAZOO CITY	MS
CH04076G	Terminated	BPS-H80-006825	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	CANTON HIGH SCHOOL HEALTH CENTER	634 Finney Rd	Canton	MS
CH04076H	Active	BPS-H80-006612	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	LINWOOD ELEMENTARY SCHOOL	3439 Vaughan Rd	Vaughan	MS
CH04076J	Active	BPS-H80-029974	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	CANTON ELEMENTARY SCHOOL	346 Van Buren St	Canton	MS
CH04076K	Active	BPS-H80-005382	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	G.A. CARMICHAEL FHC-YAZOO CITY	110 N Jerry Clower Blvd	Yazoo City	MS
CH04076L	Active	BPS-H80-004969	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	NICHOLS SCHOOL HEALTH CENTER	529 Mace St	Canton	MS
CH04076M	Terminated	BPS-H80-002245	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	HAYDEN STREET SATELLITE CLINIC	116 N Hayden St	Belzoni	MS
CH04076N	Active	BPS-H80-000808	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	YAZOO CITY HIGH SCHOOL	1825 DR MARTIN LUTHE	YAZOO CITY	MS
CH04076P	Active	BPS-H80-018843	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	Bentonia Gibbs Elementary Schools	10340 Highway 433 W	Bentonia	MS
CH04076Q	Active	BPS-H80-024821	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	G.A. Carmichael Family Health Center, Inc. Belzoni Site	1301 E First St	Belzoni	MS
CH04076R	Active	BPS-H80-031556	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	G. A. Carmichael Family Health Centers, Inc	16463 US Highway 49 Bldg	Belzoni	MS
CH04076S	Active	BPS-H80-037303	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	G. A. Carmichael Family Health Center, Inc Greenwood Site	200 Grand Blvd	Greenwood	MS
CH04076T	Active	BPS-H80-034165	G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	G. A. Carmichael Family Health Center, Inc	303 W Franklin St	Carthage	MS

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH040760	ABITACARE LLC	D/B/A VITAL CARE RX	1501 23RD AVE SUITE B	MERIDIAN	MS	39301	10/01/2024
CH040760	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	07/01/2018	03/17/2020
CH040760	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	07/01/2018
CH040760	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	07/01/2018
CH040760	B J P PHARMACY	350 W WOODROW WILSON AVE STE 311		JACKSON	MS	39213-7681	07/01/2014	03/30/2020
CH040760	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2018	08/29/2019
CH040760	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	01/01/2016
CH040760	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	01/01/2016
CH040760	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	07/01/2018	08/29/2019
CH040760	LONGS DRUGS OF LEXINGTON	D/B/A AVITA PHARMACY 1051	1216 W MAIN ST STE D	LEXINGTON	SC	29072-2453	07/01/2018	08/29/2019
CH040760	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 6396	800 EAST 15TH STREET	YAZOO CITY	MS	39194	04/21/2022
CH040760	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04997	305 MEADOWBROOK RD.	JACKSON	MS	39206	04/21/2022
CH040760	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04993	1014 HIGHWAY 51	MADISON	MS	39110	04/21/2022
CH040760	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04376	1209 SUNSET DR.	GRENADA	MS	38901	01/01/2023
CH040760	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04519	205 HIGHWAY 16 WEST	CARTHAGE	MS	39051	01/01/2023
CH040760	MISSISSIPPI CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05801	212 W. PARK AVE.	GREENWOOD	MS	38930	01/01/2023
CH040760	MISSISSIPPI DISCOUNT DRUGS LLC	195 E PEACE ST		CANTON	MS	39046-4519	04/01/2018
CH040760	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2018	08/29/2019
CH040760	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2018	08/29/2019
CH040760	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2018
CH040760	WAL-MART PHARMACY 10-3059	244 FEATHER LANE		CANTON	MS	39046	04/01/2018
CH040760	WAL-MART PHARMACY 10-3060	2129 GRAND AVENUE		YAZOO CITY	MS	39194-7271	04/01/2018
CH040760	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2018
CH040760	WALGREEN CO.	DBA: WALGREENS # 03918	3189 HWY 80 EAST	PEARL	MS	39208	10/01/2024
CH040760	WALGREEN CO.	DBA: WALGREENS #11111	1100 HWY 51	MADISON	MS	39110	10/01/2024
CH040760	WALGREEN CO.	DBA: WALGREENS # 05165	204 HIGHWAY 80 EAST	CLINTON	MS	39056	10/01/2024
CH040760	WALGREEN CO.	DBA: WALGREENS #15250	1606 HIGHLAND COLONY PARKWAY	MADISON	MS	39110	10/01/2024
CH040760	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024
CH040760	YAZOO DRUGS	730 E FIFTEENTH ST		YAZOO CITY	MS	39194	04/01/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		2/21/2022 12:00:00 AM	2/22/2022 6:38 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/22/2022 6:38 AM
Terminations	Termination Date	Update	Recertification		4/1/2022 12:00:00 AM	2/22/2022 6:38 AM
Terminations	Termination Effective Date	Update	Recertification		2/21/2022 12:00:00 AM	2/22/2022 6:38 AM
Terminations	Termination Reason	Update	Recertification		Other	2/22/2022 6:38 AM
Details	Last Recertification Date	Update	Recertification	2/6/2020 3:00:20 PM	2/3/2021 9:39:03 AM	2/3/2021 9:39 AM
Details	Last Recertification Date	Update	Recertification	1/30/2019 10:42:37 AM	2/6/2020 3:00:20 PM	2/6/2020 3:00 PM
Contacts	Primary Contact	Update	Change Request	Roby, Christopher R Grants and Program Director G.A. Carmichael Family Health Center 6018595213-2263	Knox, Joshua Chief Programs Officer G.A. Carmichael Family Health Center, Inc. 6019532188	9/3/2019 10:49 AM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		9/3/2019 10:49 AM
Details	Last Recertification Date	Update	Recertification	2/8/2018 2:07:05 PM	1/30/2019 10:42:37 AM	1/30/2019 10:42 AM
Details	Last Recertification Date	Update	Recertification	1/31/2017 12:00:00 AM	2/8/2018 2:07:05 PM	2/8/2018 2:07 PM
Contacts	Primary Contact	Update	Change Request	Roby, Christopher Grants and Program Director G.A. Carmichael Family Health Center 6018595213-2263	Roby, Christopher R Grants and Program Director G.A. Carmichael Family Health Center 6018595213-2263	1/17/2018 3:18 PM
Contacts	Authorizing Official	Update		Coleman Jr., James L. CEO 6018595213-2291	Coleman Jr., James L. CEO G. A. Carmichael Family Health Center, Inc. 6018595213-2291	1/16/2018 12:19 PM
Contacts	Primary Contact	Update		Roby, Christopher Grants and Program Director 6018595213-2263	Roby, Christopher Grants and Program Director G.A. Carmichael Family Health Center 6018595213-2263	10/4/2017 3:21 PM
Contacts	Primary Contact	Update		McKetney, Teresa Chief Medical Officer 6018595213-2048	Roby, Christopher Grants and Program Director 6018595213-2263	2/21/2017 9:50 AM
Contacts	Signed By	Insert			Bacon, Janice Executive Director 6018595213-0288	1/31/2017 2:27 PM
Contacts	Authorizing Official	Insert			Coleman Jr., James L. CEO 6018595213-2291	1/31/2017 2:27 PM
Addresses	Main Address	Insert			116 N Hayden St Belzoni, MS 39038-3932	1/31/2017 2:27 PM
Details	Last Recertification Date	Update		2/29/2016 12:00:00 AM	1/31/2017 12:00:00 AM	1/31/2017 2:27 PM
Contacts	Primary Contact	Insert			McKetney, Teresa Chief Medical Officer 6018595213-2048	1/31/2017 2:26 PM
Details	Last Recertification Date	Update		2/10/2015 12:00:00 AM	2/29/2016 12:00:00 AM	2/29/2016 10:51 AM
Details	Last Recertification Date	Update		3/16/2014 12:00:00 AM	2/10/2015 12:00:00 AM	2/10/2015 4:01 PM
Details	Is Authorizing Official EHB Data	Update			False	2/10/2015 4:01 PM
Details	Last Recertification Date	Update			3/16/2014 12:00:00 AM	3/16/2014 3:02 PM
Dates	Participating Approval Date	Update			9/13/2013 12:00:00 AM	9/13/2013 8:56 PM
Details	State	Update		Pending	Active	9/13/2013 8:56 PM
Dates	Start Date	Update			10/1/2013 12:00:00 AM	9/13/2013 8:56 PM
Details	340B ID	Update		CH040760M	CH04076M	9/3/2013 2:15 PM
Details	340B ID	Update		ONLINE_REG	CH040760M	7/25/2013 2:56 PM
Details	Last Recertification Date	Insert				7/2/2013 1:34 PM
Details	Grant Number	Insert			H80CS00484	7/2/2013 1:34 PM
Details	340B ID	Insert			ONLINE_REG	7/2/2013 1:34 PM
Details	Is Authorizing Official EHB Data	Insert				7/2/2013 1:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/2/2013 1:34 PM
Details	Medicare Provider Number	Insert				7/2/2013 1:34 PM
Details	Entity Name	Insert			G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.	7/2/2013 1:34 PM
Details	Program Code	Insert			CH	7/2/2013 1:34 PM
Details	Entity Subname	Insert			HAYDEN STREET SATELLITE CLINIC	7/2/2013 1:34 PM
Dates	Participating Approval Date	Insert				7/2/2013 1:34 PM
Details	State	Insert			Pending	7/2/2013 1:34 PM
Dates	Registration Date	Insert			7/2/2013 12:00:00 AM	7/2/2013 1:34 PM
Dates	Signed By Date	Insert			7/2/2013 12:00:00 AM	7/2/2013 1:34 PM
Dates	Start Date	Insert				7/2/2013 1:34 PM
Terminations	Termination Comments	Insert				7/2/2013 1:34 PM
Terminations	Termination Date	Insert				7/2/2013 1:34 PM
Terminations	Termination Effective Date	Insert				7/2/2013 1:34 PM
Terminations	Termination Reason	Insert				7/2/2013 1:34 PM

340B Drug Pricing Program Database