Covered Entity Details

CH04211P GEORGIA MOUNTAINS HEALTH SERVICES, INC. (Active) - information as of 6/25/2025 12:53:48 AM

Main Details

Name

GEORGIA MOUNTAINS HEALTH SERVICES, INC.

Subdivision Name

Fannin County Medical and Admin consolidated site

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013410

340B ID

CH04211P

Grant Number

H80CS00093

Additional Details

Current Program Status

Active

Registration Date

1/15/2014

Participating Start Date

4/1/2014

Participating Approval Date

2/25/2014

Last Recertification Date

2/13/2025

Contacts

Authorizing Official

Georgia Mountains Health Services, Inc
Steven Miracle, CEO
(706) 946-5610

Primary Contact

Georgia Mtns Health
Randy Westbrook, CFO
(706) 946-5609

Addresses

Street Address

165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431

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?
Yes

State	Medicaid Number	NPI Number
GA	000236519A	1538123666

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	BRASSTOWN PROFESSIONAL PHCY	23 MURPHY HWY STE B		BLAIRSVILLE	GA	30512	04/03/2018	07/01/2018	01/12/2021	11/06/2023
Contract Detail	CORNER DRUGS INC	CORNER DRUGS	430 N 3RD AVE	CHATSWORTH	GA	30705-3070	07/16/2021	10/01/2021	03/23/2022	03/29/2022
Contract Detail	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	04/13/2015	07/01/2015	01/15/2023	11/06/2023
Contract Detail	DAHLONEGA PHARMACY INC	ROBERT A LEDBETTER	70 MEMORIAL DR	DAHLONEGA	GA	30533	04/13/2015	07/01/2015	01/29/2016	04/29/2016
Contract Detail	FAMILY PHARMACY	1100 E WALNUT AVE STE 17		DALTON	GA	30721	04/13/2015	07/01/2015	12/04/2015	04/29/2016
Contract Detail	FOOD CITY PHARMACY #230	502 GI MADDOX PARKWAY		CHATSWORTH	GA	30705	07/07/2021	10/01/2021	05/31/2024	06/09/2024
Contract Detail	INGLES MARKETS #86	964 G I MADDOX PARKWAY		CHATSWORTH	GA	30705	10/15/2018	01/01/2019	05/29/2019	05/30/2019
Contract Detail	INGLES MARKETS PHARMACY #409	100 OLD ORCHARD SQUARE		ELLIJAY	GA	30540	10/15/2018	01/01/2019	05/29/2019	05/30/2019
Contract Detail	INGLES MARKETS PHARMACY #98	207 B HWY 515		BLAIRSVILLE	GA	30512	10/15/2018	01/01/2019	05/29/2019	05/30/2019
Contract Detail	INGLES PHARMACY #36	5679 APPALACHIAN HWY		BLUE RIDGE	GA	30513	10/15/2018	01/01/2019	05/29/2019	05/30/2019
Contract Detail	LIVING WELL CENTRAL PHARMACY	2976 HIGHWAY 76 UNIT A		CHATSWORTH	GA	30705-6982	04/13/2015	07/01/2015	06/12/2021	11/06/2023
Contract Detail	LIVING WELL EXPRESS PHARMACY	824 G I MADDOX PKWY	UNIT B	CHATSWORTH	GA	30705	07/03/2019	10/01/2019	06/12/2021	11/06/2023
Contract Detail	LIVING WELL PHARMACY	79 HWY 286	UNIT A	ETON	GA	30724-0369	10/02/2015	01/01/2016	06/12/2021	11/06/2023
Contract Detail	MULLINS PHARMACY PC	24 ALICIA LN STE 2		DAHLONEGA	GA	30533	04/13/2015	07/01/2015	09/01/2020	10/14/2020
Contract Detail	PURVIS PHARMACIES,P.C.	DBA: HUFF'S DRUG STORE	136 INDUSTRIAL BLVD	ELLIJAY	GA	30540	04/13/2015	07/01/2015		04/13/2015
Contract Detail	SOUTHERN DRUG COMPANY, INC	4075 E FIRST ST		BLUE RIDGE	GA	30513-4526	04/03/2018	07/01/2018		04/03/2018
Contract Detail	T AND P PHARMACY	DBA: BLUE RIDGE PHARMACY	6020 APPALACHIAN HWY	BLUE RIDGE	GA	30513	04/13/2015	07/01/2015		04/13/2015
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/09/2017	04/01/2017	05/31/2025	06/02/2025
Contract Detail	WAL-MART PHARMACY #10-5812	97 COMMERCE DRIVE		BLUE RIDGE	GA	30513	04/13/2015	07/01/2015	05/31/2025	06/02/2025
Contract Detail	WAL-MART PHARMACY 10-0669	2545 E WALNUT AVE		DALTON	GA	30721	04/13/2015	07/01/2015	01/22/2022	11/06/2023
Contract Detail	WAL-MART PHARMACY 10-1070	88 HIGHLAND CROSSING		EAST ELLIJAY	GA	30540	04/13/2015	07/01/2015	05/31/2025	06/02/2025
Contract Detail	WAL-MART PHARMACY 10-2513	270 WAL-MART-WAY		DAHLONEGA	GA	30533	10/15/2020	01/01/2021	05/31/2025	06/02/2025
Contract Detail	WAL-MART PHARMACY 10-3485	2257 HWY 515		BLAIRSVILLE	GA	30512	01/07/2016	04/01/2016	05/23/2016	05/23/2016
Contract Detail	WAL-MART PHARMACY 10-5173	815 SHUGART RD		DALTON(W)	GA	30720	10/13/2017	01/01/2018	04/26/2019	11/22/2019
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	07/14/2020	10/01/2020	05/31/2025	06/02/2025
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/09/2017	04/01/2017	05/31/2025	06/02/2025
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/06/2023	10/01/2023	10/06/2023	11/06/2023
Contract Detail	WAUKA MOUNTAIN PHARMACY, INC	WAUKA MOUNTAIN PHARMACY	5233 CLEVELAND HWY PO BOX 410	CLERMONT	GA	30527	10/15/2020	01/01/2021		01/01/2021
Contract Detail	WOODY'S LONGBRANCH PHARMACY, INC.	DBA WOODY'S PHARMACY	130 LONG BRANCH RD	DAHLONEGA	GA	30533	01/11/2021	04/01/2021		04/01/2021

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH042110	Terminated	BPS-H80-013410	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	MORGANTON	165 Blue Ridge Overlook		Blue Ridge	GA
CH04211C	Active	BPS-H80-036658	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	Ellijay Health and Dental	80 Cinema Drive		Ellijay	GA
CH04211G	Active	BPS-H80-003654	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	Chatsworth Clinic	1008 N 3rd Ave		Chatsworth	GA
CH04211J	Terminated	BPS-H80-001724	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	BLUE RIDGE DENTAL	990 E Main St		Blue Ridge	GA
CH04211L	Terminated	BPS-H80-011961	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	Dalton Community Center Clinic	218 N Fredrick St		Dalton	GA
CH04211M	Terminated	BPS-H80-010472	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	Mobile Van #1	772 Maddox Dr STE 120		East Ellijay	GA
CH04211N	Terminated	BPS-H80-012543	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	Appalachian Integrated Care and Wellness Program	900 Shugart Rd		Dalton	GA
CH04211P	Active	BPS-H80-013410	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	Fannin County Medical and Admin consolidated site	165 Blue Ridge Overlook		Blue Ridge	GA
CH04211Q	Active	BPS-H80-013744	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	Lumpkin Health Center	134 Ansley Drive Suite	Suite 700	Dahlonega	GA
CH04211R	Terminated	BPS-H80-014203	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	AIM - Ellijay	1179 PROGRESS RD		ELLIJAY	GA
CH04211S	Active	BPS-H80-017410	GEORGIA MOUNTAINS HEALTH SERVICES, INC.	School Based Health Center - Chatsworth Elementary School	500 Green Road		Chastworth	GA
CH04211T	Terminated	BPS-H80-021257	Georgia Mountains Health Services, Inc.	Superfriendly Dental	160 Sailors Dr		Ellijay	GA
CH04211U	Active	BPS-H80-027454	GEORGIA MOUNTAINS HEALTH SERVICES INC	Georgia Mountains Health - Dahlonega Ste 700	134 Ansley Dr Ste 700		Dahlonega	GA
CH04211V	Active	BPS-H80-036891	GEORGIA MOUNTAINS HEALTH SERVICES INC	Healthy Kids + Lumpkin	153 School Dr		Dahlonega	GA
CH04211W	Active	BPS-H80-039452	GEORGIA MOUNTAINS HEALTH SERVICES INC	Blue Ridge BH and Admin	79 Blue Ridge Overlook		Blue Ridge	GA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH04211P	BRASSTOWN PROFESSIONAL PHCY	23 MURPHY HWY STE B		BLAIRSVILLE	GA	30512	07/01/2018	01/12/2021
CH04211P	CORNER DRUGS INC	CORNER DRUGS	430 N 3RD AVE	CHATSWORTH	GA	30705-3070	10/01/2021	03/23/2022
CH042110	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	04/01/2015	10/01/2015
CH04211P	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	07/01/2015	01/15/2023
CH04211P	DAHLONEGA PHARMACY INC	ROBERT A LEDBETTER	70 MEMORIAL DR	DAHLONEGA	GA	30533	07/01/2015	01/29/2016
CH042110	FAMILY PHARMACY	1100 E WALNUT AVE STE 17		DALTON	GA	30721	07/01/2013	10/01/2015
CH04211P	FAMILY PHARMACY	1100 E WALNUT AVE STE 17		DALTON	GA	30721	07/01/2015	12/04/2015
CH04211P	FOOD CITY PHARMACY #230	502 GI MADDOX PARKWAY		CHATSWORTH	GA	30705	10/01/2021	05/31/2024
CH04211P	INGLES MARKETS #86	964 G I MADDOX PARKWAY		CHATSWORTH	GA	30705	01/01/2019	05/29/2019
CH04211P	INGLES MARKETS PHARMACY #409	100 OLD ORCHARD SQUARE		ELLIJAY	GA	30540	01/01/2019	05/29/2019
CH04211P	INGLES MARKETS PHARMACY #98	207 B HWY 515		BLAIRSVILLE	GA	30512	01/01/2019	05/29/2019
CH04211P	INGLES PHARMACY #36	5679 APPALACHIAN HWY		BLUE RIDGE	GA	30513	01/01/2019	05/29/2019
CH042110	LIVING WELL CENTRAL PHARMACY	2976 HIGHWAY 76 UNIT A		CHATSWORTH	GA	30705-6982	08/09/2011	10/01/2015
CH04211P	LIVING WELL CENTRAL PHARMACY	2976 HIGHWAY 76 UNIT A		CHATSWORTH	GA	30705-6982	07/01/2015	06/12/2021
CH04211P	LIVING WELL EXPRESS PHARMACY	824 G I MADDOX PKWY	UNIT B	CHATSWORTH	GA	30705	10/01/2019	06/12/2021
CH04211P	LIVING WELL PHARMACY	79 HWY 286	UNIT A	ETON	GA	30724-0369	01/01/2016	06/12/2021
CH042110	MULLINS PHARMACY PC	24 ALICIA LN STE 2		DAHLONEGA	GA	30533	07/01/2014	10/01/2015
CH04211P	MULLINS PHARMACY PC	24 ALICIA LN STE 2		DAHLONEGA	GA	30533	07/01/2015	09/01/2020
CH042110	PURVIS PHARMACIES,P.C.	DBA: HUFF'S DRUG STORE	136 INDUSTRIAL BLVD	ELLIJAY	GA	30540	05/24/2011	10/01/2015
CH04211P	PURVIS PHARMACIES,P.C.	DBA: HUFF'S DRUG STORE	136 INDUSTRIAL BLVD	ELLIJAY	GA	30540	07/01/2015
CH04211P	SOUTHERN DRUG COMPANY, INC	4075 E FIRST ST		BLUE RIDGE	GA	30513-4526	07/01/2018
CH042110	T AND P PHARMACY	DBA: BLUE RIDGE PHARMACY	6020 APPALACHIAN HWY	BLUE RIDGE	GA	30513	05/24/2011	10/01/2015
CH04211P	T AND P PHARMACY	DBA: BLUE RIDGE PHARMACY	6020 APPALACHIAN HWY	BLUE RIDGE	GA	30513	07/01/2015
CH04211P	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2017	05/31/2025
CH042110	WAL-MART PHARMACY #10-5812	97 COMMERCE DRIVE		BLUE RIDGE	GA	30513	10/01/2014	10/01/2015
CH04211P	WAL-MART PHARMACY #10-5812	97 COMMERCE DRIVE		BLUE RIDGE	GA	30513	07/01/2015	05/31/2025
CH042110	WAL-MART PHARMACY 10-0669	2545 E WALNUT AVE		DALTON	GA	30721	07/01/2014	10/01/2015
CH04211P	WAL-MART PHARMACY 10-0669	2545 E WALNUT AVE		DALTON	GA	30721	07/01/2015	01/22/2022
CH042110	WAL-MART PHARMACY 10-1070	88 HIGHLAND CROSSING		EAST ELLIJAY	GA	30540	04/13/2012	10/01/2015
CH04211P	WAL-MART PHARMACY 10-1070	88 HIGHLAND CROSSING		EAST ELLIJAY	GA	30540	07/01/2015	05/31/2025
CH04211P	WAL-MART PHARMACY 10-2513	270 WAL-MART-WAY		DAHLONEGA	GA	30533	01/01/2021	05/31/2025
CH04211P	WAL-MART PHARMACY 10-3485	2257 HWY 515		BLAIRSVILLE	GA	30512	04/01/2016	05/23/2016
CH04211P	WAL-MART PHARMACY 10-5173	815 SHUGART RD		DALTON(W)	GA	30720	01/01/2018	04/26/2019
CH04211P	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/01/2020	05/31/2025
CH04211P	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2017	05/31/2025
CH04211P	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2023	10/06/2023
CH04211P	WAUKA MOUNTAIN PHARMACY, INC	WAUKA MOUNTAIN PHARMACY	5233 CLEVELAND HWY PO BOX 410	CLERMONT	GA	30527	01/01/2021
CH04211P	WOODY'S LONGBRANCH PHARMACY, INC.	DBA WOODY'S PHARMACY	130 LONG BRANCH RD	DAHLONEGA	GA	30533	04/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 9:05:34 AM	2/13/2025 9:55:20 AM	2/13/2025 9:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/6/2024 9:02 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		000236519A	11/6/2024 9:02 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	11/6/2024 9:02 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1538123666	11/6/2024 9:02 AM
Medicaid Billing	NPI: State	Insert	Change Request		GA	11/6/2024 9:02 AM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		11/6/2024 9:02 AM
Details	Last Recertification Date	Update	Recertification	2/4/2023 4:52:14 PM	1/29/2024 9:05:34 AM	1/29/2024 9:05 AM
Details	Last Recertification Date	Update	Recertification	2/3/2022 9:38:54 AM	2/4/2023 4:52:14 PM	2/4/2023 4:52 PM
Details	Last Recertification Date	Update	Recertification	2/14/2021 4:17:49 PM	2/3/2022 9:38:54 AM	2/3/2022 9:38 AM
Details	Last Recertification Date	Update	Recertification	1/30/2020 1:36:56 PM	2/14/2021 4:17:49 PM	2/14/2021 4:17 PM
Details	Last Recertification Date	Update	Recertification	1/30/2019 7:06:59 PM	1/30/2020 1:36:56 PM	1/30/2020 1:36 PM
Details	Last Recertification Date	Update	Recertification	2/9/2018 3:53:46 PM	1/30/2019 7:06:59 PM	1/30/2019 7:06 PM
Details	Last Recertification Date	Update	Recertification	2/4/2017 12:00:00 AM	2/9/2018 3:53:46 PM	2/9/2018 3:53 PM
Contacts	Authorizing Official	Update		Miracle, Steven CEO 7069465610	Miracle, Steven CEO Georgia Mountains Health Services, Inc 7069465610	10/13/2017 6:13 PM
Contacts	Signed By	Update		Miracle, Steven CEO 7069465610	Miracle, Steven CEO Georgia Mountains Health Services, Inc 7069465610	10/13/2017 6:13 PM
Contacts	Primary Contact	Update		Westbrook, Randy CFO 7069465609	Westbrook, Randy CFO Georgia Mtns Health 7069465609	10/10/2017 10:34 AM
Contacts	Primary Contact	Insert			Westbrook, Randy CFO 7069465609	2/6/2017 1:21 PM
Contacts	Authorizing Official	Insert			Miracle, Steven CEO 7069465610	2/6/2017 1:21 PM
Contacts	Signed By	Insert			Miracle, Steven CEO 7069465610	2/6/2017 1:21 PM
Addresses	Main Address	Insert			165 Blue Ridge Overlook Blue Ridge, GA 30513-4431	2/4/2017 11:05 AM
Details	Last Recertification Date	Update		2/23/2016 12:00:00 AM	2/4/2017 12:00:00 AM	2/4/2017 11:05 AM
Details	Last Recertification Date	Update		2/3/2015 12:00:00 AM	2/23/2016 12:00:00 AM	2/23/2016 8:48 AM
Details	Last Recertification Date	Update			2/3/2015 12:00:00 AM	2/3/2015 12:42 PM
Details	Is Authorizing Official EHB Data	Update			False	10/10/2014 10:26 AM
Details	340B ID	Update		ONLINE_REG	CH04211P	2/25/2014 4:20 PM
Dates	Participating Approval Date	Update			2/25/2014 12:00:00 AM	2/25/2014 4:20 PM
Details	State	Update		Pending	Active	2/25/2014 4:20 PM
Dates	Start Date	Update			4/1/2014 12:00:00 AM	2/25/2014 4:20 PM
Details	Last Recertification Date	Insert				1/15/2014 11:54 AM
Details	Grant Number	Insert			H80CS00093	1/15/2014 11:54 AM
Details	340B ID	Insert			ONLINE_REG	1/15/2014 11:54 AM
Details	Is Authorizing Official EHB Data	Insert				1/15/2014 11:54 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/15/2014 11:54 AM
Details	Medicare Provider Number	Insert				1/15/2014 11:54 AM
Details	Entity Name	Insert			GEORGIA MOUNTAINS HEALTH SERVICES, INC.	1/15/2014 11:54 AM
Details	Program Code	Insert			CH	1/15/2014 11:54 AM
Details	Entity Subname	Insert			Fannin County Medical and Admin consolidated site	1/15/2014 11:54 AM
Dates	Participating Approval Date	Insert				1/15/2014 11:54 AM
Details	State	Insert			Pending	1/15/2014 11:54 AM
Dates	Registration Date	Insert			1/15/2014 12:00:00 AM	1/15/2014 11:54 AM
Dates	Signed By Date	Insert			1/15/2014 12:00:00 AM	1/15/2014 11:54 AM
Dates	Start Date	Insert				1/15/2014 11:54 AM
Terminations	Termination Comments	Insert				1/15/2014 11:54 AM
Terminations	Termination Date	Insert				1/15/2014 11:54 AM
Terminations	Termination Effective Date	Insert				1/15/2014 11:54 AM
Terminations	Termination Reason	Insert				1/15/2014 11:54 AM

340B Drug Pricing Program Database