Details | Last Recertification Date | Update | Recertification | 1/31/2024 12:21:49 PM | 2/12/2025 9:19:06 AM | 2/12/2025 9:19 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 1/23/2025 1:58 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 000580255 | 1/23/2025 1:58 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | MS | 1/23/2025 1:58 PM |
Medicaid Billing | NPI: Number | Insert | Change Request | | 1548327463 | 1/23/2025 1:58 PM |
Medicaid Billing | NPI: State | Insert | Change Request | | MS | 1/23/2025 1:58 PM |
Details | Last Recertification Date | Update | Recertification | 1/31/2023 10:07:02 AM | 1/31/2024 12:21:49 PM | 1/31/2024 12:21 PM |
Contacts | Primary Contact | Update | Change Request | Torry, Cedric Demond
Chief Pharmacy Officer
G.A. Carmichael Family Health Center
6018595213-2311 | Lewis, Natasha
Chief Pharmacy Officer
G.A. Carmichael Family Health Center, Inc.
6018595213-2311 | 10/19/2023 5:41 PM |
Details | Last Recertification Date | Update | Recertification | 2/22/2022 8:33:50 AM | 1/31/2023 10:07:02 AM | 1/31/2023 10:07 AM |
Contacts | Primary Contact | Update | Contract Pharmacy Registration | Torry, Cedric
Chief Pharmacy Officer
G.A. Carmichael Family Health Center
6018595213-2311 | Torry, Cedric Demond
Chief Pharmacy Officer
G.A. Carmichael Family Health Center
6018595213-2311 | 10/14/2022 1:37 PM |
Contacts | Primary Contact | Update | Recertification | Knox, Joshua
Chief Programs Officer
G.A. Carmichael Family Health Center, Inc.
6019532188 | Torry, Cedric
Chief Pharmacy Officer
G.A. Carmichael Family Health Center
6018595213-2311 | 2/22/2022 8:33 AM |
Details | Last Recertification Date | Update | Recertification | 2/3/2021 9:35:23 AM | 2/22/2022 8:33:50 AM | 2/22/2022 8:33 AM |
Details | Last Recertification Date | Update | Recertification | 2/6/2020 2:59:03 PM | 2/3/2021 9:35:23 AM | 2/3/2021 9:35 AM |
Details | Last Recertification Date | Update | Recertification | 1/30/2019 10:41:08 AM | 2/6/2020 2:59:03 PM | 2/6/2020 2:59 PM |
Contacts | Primary Contact | Update | Change Request | Bowers, Troy A
Chief Programs Officer
G.A. Carmichael Family Health Center, Inc.
6018595213 | Knox, Joshua
Chief Programs Officer
G.A. Carmichael Family Health Center, Inc.
6019532188 | 9/3/2019 10:51 AM |
Contacts | Primary Contact | Update | Profile Change Request | Bowers, Troy
Chief Programs Officer
G.A. Carmichael Family Health Center, Inc.
6018595213 | Bowers, Troy A
Chief Programs Officer
G.A. Carmichael Family Health Center, Inc.
6018595213 | 2/7/2019 8:12 PM |
Contacts | Primary Contact | Update | Recertification | Roby, Christopher R
Grants and Program Director
G.A. Carmichael Family Health Center
6018595213-2263 | Bowers, Troy
Chief Programs Officer
G.A. Carmichael Family Health Center, Inc.
6018595213 | 1/30/2019 10:41 AM |
Details | Last Recertification Date | Update | Recertification | 2/8/2018 2:07:27 PM | 1/30/2019 10:41:08 AM | 1/30/2019 10:41 AM |
Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 1/30/2019 10:41 AM |
Details | Last Recertification Date | Update | Recertification | 1/31/2017 12:00:00 AM | 2/8/2018 2:07:27 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 | | |
6789 HIGHWAY 49 FRON
YAZOO CITY, MS 39194-4476 | 1/31/2017 2:26 PM |
Details | Last Recertification Date | Update | | 2/29/2016 12:00:00 AM | 1/31/2017 12:00:00 AM | 1/31/2017 2:26 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 10:52 AM |
Details | Last Recertification Date | Update | | 3/16/2014 12:00:00 AM | 2/10/2015 12:00:00 AM | 2/10/2015 4:00 PM |
Details | Is Authorizing Official EHB Data | Update | | | False | 2/10/2015 4:00 PM |
Details | Last Recertification Date | Update | | | 3/16/2014 12:00:00 AM | 3/16/2014 3:01 PM |
Dates | Participating Approval Date | Update | | | 9/13/2013 12:00:00 AM | 9/13/2013 8:55 PM |
Details | State | Update | | Pending | Active | 9/13/2013 8:55 PM |
Dates | Start Date | Update | | | 10/1/2013 12:00:00 AM | 9/13/2013 8:55 PM |
Details | 340B ID | Update | | CH040760F | CH04076F | 9/3/2013 2:13 PM |
Details | 340B ID | Update | | ONLINE_REG | CH040760F | 7/25/2013 2:46 PM |
Details | Last Recertification Date | Insert | | | | 7/2/2013 2:11 PM |
Details | Grant Number | Insert | | | H80CS00484 | 7/2/2013 2:11 PM |
Details | 340B ID | Insert | | | ONLINE_REG | 7/2/2013 2:11 PM |
Details | Is Authorizing Official EHB Data | Insert | | | | 7/2/2013 2:11 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/2/2013 2:11 PM |
Details | Medicare Provider Number | Insert | | | | 7/2/2013 2:11 PM |
Details | Entity Name | Insert | | | G.A. CARMICHAEL FAMILY HEALTH CENTER, INC. | 7/2/2013 2:11 PM |
Details | Program Code | Insert | | | CH | 7/2/2013 2:11 PM |
Details | Entity Subname | Insert | | | YAZOO COUNTY HIGH SCHOOL | 7/2/2013 2:11 PM |
Dates | Participating Approval Date | Insert | | | | 7/2/2013 2:11 PM |
Details | State | Insert | | | Pending | 7/2/2013 2:11 PM |
Dates | Registration Date | Insert | | | 7/2/2013 12:00:00 AM | 7/2/2013 2:11 PM |
Dates | Signed By Date | Insert | | | 7/2/2013 12:00:00 AM | 7/2/2013 2:11 PM |
Dates | Start Date | Insert | | | | 7/2/2013 2:11 PM |
Terminations | Termination Comments | Insert | | | | 7/2/2013 2:11 PM |
Terminations | Termination Date | Insert | | | | 7/2/2013 2:11 PM |
Terminations | Termination Effective Date | Insert | | | | 7/2/2013 2:11 PM |
Terminations | Termination Reason | Insert | | | | 7/2/2013 2:11 PM |