Covered Entity Details

CAH251302-09 PIONEER COMMUNITY HOSP OF ABERDEEN (Terminated) - information as of 5/4/2025 10:24:02 PM

Main Details

Name

PIONEER COMMUNITY HOSP OF ABERDEEN

Subdivision Name

Pioneer Outpatient Behavioral Health of Columbus

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH251302-09

Medicare Provider Number

251302

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/15/2014

Participating Start Date

1/1/2015

Participating Approval Date

11/19/2014

Last Recertification Date

8/31/2015

Termination Date
Termination Reason

10/1/2016
Site closure

Contacts

Authorizing Official

Boa Vida Hospital of Aberdeen LLC., dba Monroe Regional Hospital
Chris Chandler, CEO
(662) 369-2455

Primary Contact

Monroe Regional Hospital
Amanda Williams, Pharmacy Director
(662) 369-2455

Addresses

Street Address

2625 5th Street North
Columbus, MS 39705

Billing Address
Same as Street Address

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?
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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH251302-01	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	NINA JURNEY CLINIC	502 JACKSON ST.	ABERDEEN	MS	Active
CAH251302-02	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	Monroe Regional Hospital Medical Group Chestnut	502 JACKSON ST	ABERDEEN	MS	Active
CAH251302-03	Child	CAH	PIONEER HEALTH SERVICES OF MONROE COUNTY, INC. D/B/A PIONEER COMMUNITY HOSPITAL	PIONEER FAMILY MEDICAL OF AMORY	1506 HWY 278 E.	AMORY	MS	Terminated
CAH251302-05	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	Monroe Regional Hospital Medical Group Hamilton	40128 HAMILTON RD.	HAMILTON	MS	Active
CAH251302-06	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	Monroe Regional Hospital Medical Group	502 JACKSON ST	ABERDEEN	MS	Active
CAH251302-07	Child	CAH	PIONEER COMMUNITY HOSP OF ABERDEEN	Pioneer Outpatient Behavioral Health of Amory	60387 Cotton Gin Port Road	Amory	MS	Terminated
CAH251302-08	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	Monroe Regional Hospital Outpt Behavorial Health of Aberdeen	405 S. Chestnut Street	Aberdeen	MS	Active
CAH251302-09	Child	CAH	PIONEER COMMUNITY HOSP OF ABERDEEN	Pioneer Outpatient Behavioral Health of Columbus	2625 5th Street North	Columbus	MS	Terminated
CAH251302-10	Child	CAH	PIONEER COMMUNITY HOSP OF ABERDEEN	Pioneer Outpatient Behavioral Health of Starkville	106 Strange Road	Starkville	MS	Terminated
CAH251302-11	Child	CAH	PIONEER HEALTH SERVICES OF MONROE COUNTY, INC. D/B/A PIONEER COMMUNITY HOSPITAL	Pioneer Outpatient Behavioral Health of Okolona	253 West Main Street	Okolona	MS	Terminated
CAH251302-12	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Aberdeen	502 Jackson St	Aberdeen	MS	Terminated
CAH251302-13	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Starkville	900 Stark Rd	Starkville	MS	Terminated
CAH251302-14	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Chestnut	502 Jackson St	Aberdeen	MS	Terminated
CAH251302-15	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Columbus 5th St	2200 5th St. N	Columbus	MS	Terminated
CAH251302-16	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Columbus Women's Wellness	505 Willowbrook Rd	Columbus	MS	Terminated
CAH251302-17	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial - Hamilton	40128 Hamilton Rd	Hamilton	MS	Terminated
CAH251302-18	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Jurney	502 Jackson St.	Aberdeen	MS	Terminated
CAH251302-19	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group Columbus 5th Street	2200 5th Street North	Columbus	MS	Active
CAH251302-20	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group Columbus Women's Wellness	505 Willowbrook Road	Columbus	MS	Active
CAH251302-21	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group Starkville	807 MS-12 W	Starkville	MS	Active
CAH251302-22	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, Nettleton	1495 Maple Rd.	Nettleton	MS	Active
CAH251302-23	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, Sherman	670 Hwy 178 W, Suite 5	Sherman	MS	Active
CAH251302-24	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, Corinth Alcorn Dr.	508 Alcorn Drive	Corinth	MS	Active
CAH251302-25	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, GSV Houlka	400 3rd Avenue Hwy 32 West	Houlka	MS	Active
CAH251302-26	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, West Point OB/GYN & Primary Care	116 Medical Center Dr.	West Point	MS	Active
CAH251302-27	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, Belmont	19 3rd Street	Belmont	MS	Active
CAH251302-28	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Premier Diabetes and Medical Clinic	2394 McCullough Blvd.	Belden	MS	Active
CAH251302-29	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Acute Care and Family Clinic of Pontotoc	351 Peoples Drive	Pontotoc	MS	Active
CAH251302-30	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - East Main Family Medical	1424 E. Main St.	Tupelo	MS	Active
CAH251302-31	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Verona Family Medicine and Urgent Care	5024 Raymond Ave.	Tupelo	MS	Active
CAH251302-32	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Horn Family Medical Clinic	457 E. Madison Street	Houston	MS	Active
CAH251302-33	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Brown Medical Clinic	401 S. Chestnut St.	Aberdeen	MS	Active
CAH251302-34	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Rice Family Medical Clinic	120 Burke Calhoun City Rd.	Calhoun City	MS	Active
CAH251302-35	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Potter Family Clinic	1462A Hwy 1 South	Greenville	MS	Active
CAH251302-36	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRHMG - Caretime Medical Clinic	1506 US 278A	Amory	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Chandler, Chris CEO Monroe Regional Hospital 6623692455	Chandler, Chris CEO Boa Vida Hospital of Aberdeen LLC., dba Monroe Regional Hospital 6623692455	3/12/2018 4:32 PM
Contacts	Authorizing Official	Update	Profile Change Request	Chandler, Chris CEO Monroe Regional Hospital 6623692150	Chandler, Chris CEO Monroe Regional Hospital 6623692455	3/9/2018 3:40 PM
Contacts	Authorizing Official	Update		Chandler, Chris CEO 6623692150	Chandler, Chris CEO Monroe Regional Hospital 6623692150	10/12/2017 11:57 AM
Contacts	Primary Contact	Update		Williams, Amanda Pharmacy Director 6623692455	Williams, Amanda Pharmacy Director Monroe Regional Hospital 6623692455	10/9/2017 10:58 AM
Contacts	Authorizing Official	Update		McNulty III, Joseph S. President 6018496440	Chandler, Chris CEO 6623692150	9/11/2017 3:29 PM
Contacts	Authorizing Official	Insert			McNulty III, Joseph S. President 6018496440	8/8/2017 3:13 PM
Contacts	Signed By	Insert			McNulty III, Joseph S. President 6018496440	8/8/2017 3:13 PM
Contacts	Primary Contact	Insert			Williams, Amanda Pharmacy Director 6623692455	6/30/2017 7:27 AM
Addresses	Main Address	Insert			2625 5th Street North Columbus, MS 39705	7/21/2016 12:02 PM
Dates	Last Date That 340B Drugs Purchased	Update			1/1/2016 12:00:00 AM	7/21/2016 12:02 PM
Details	State	Update		Active	Terminated	7/21/2016 12:02 PM
Terminations	Termination Date	Update			10/1/2016 12:00:00 AM	7/21/2016 12:02 PM
Terminations	Termination Effective Date	Update			5/15/2016 12:00:00 AM	7/21/2016 12:02 PM
Terminations	Termination Reason	Update			Site closure	7/21/2016 12:02 PM
Details	Last Recertification Date	Update			8/31/2015 12:00:00 AM	8/31/2015 5:31 PM
Dates	Participating Approval Date	Update			11/19/2014 12:00:00 AM	11/19/2014 6:16 AM
Details	State	Update		Pending	Active	11/19/2014 6:16 AM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	11/19/2014 6:16 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_47631	CAH251302-09	10/16/2014 10:47 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_47631	10/15/2014 5:49 PM
Details	Last Recertification Date	Insert				10/15/2014 5:49 PM
Details	Grant Number	Insert				10/15/2014 5:49 PM
Details	340B ID	Insert				10/15/2014 5:49 PM
Details	Is Authorizing Official EHB Data	Insert				10/15/2014 5:49 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2014 5:49 PM
Details	Medicare Provider Number	Insert			251302	10/15/2014 5:49 PM
Details	Entity Name	Insert			PIONEER COMMUNITY HOSP OF ABERDEEN	10/15/2014 5:49 PM
Details	Program Code	Insert			CAH	10/15/2014 5:49 PM
Details	Entity Subname	Insert			Pioneer Outpatient Behavioral Health of Columbus	10/15/2014 5:49 PM
Dates	Participating Approval Date	Insert				10/15/2014 5:49 PM
Details	State	Insert			Pending	10/15/2014 5:49 PM
Dates	Registration Date	Insert			10/15/2014 12:00:00 AM	10/15/2014 5:49 PM
Dates	Signed By Date	Insert			10/15/2014 12:00:00 AM	10/15/2014 5:49 PM
Dates	Start Date	Insert				10/15/2014 5:49 PM
Terminations	Termination Comments	Insert				10/15/2014 5:49 PM
Terminations	Termination Date	Insert				10/15/2014 5:49 PM
Terminations	Termination Effective Date	Insert				10/15/2014 5:49 PM
Terminations	Termination Reason	Insert				10/15/2014 5:49 PM