340B Drug Pricing Program Database


CHC00836-08 SOUTH CENTRAL PRIMARY CARE CENTER (Terminated) - information as of 6/14/2025 10:04:31 AM

Main Details
SOUTH CENTRAL PRIMARY CARE CENTER
South Central Women's Health
HRSA-Funded Health Center
BPS-H80-013973
CHC00836-08
H80CS00836


Additional Details
Terminated
1/15/2015
4/1/2015
1/22/2015
1/29/2024

10/1/2024
Business decision by the Covered Entity

Contacts

South Central Primary Care Center, Inc.
Robert B. Tucker, CEO
(229) 468-9166 Ext: 1

South Central Primary Care Center, Inc.
Judy Swanson, Nurse Manager
(229) 468-9166

Addresses

119 Norman Dorminy Dr. Suite B
Fitzgerald, GA 31750-8855

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailCURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371601/12/201704/01/2017 10/01/202410/01/2024
Contract DetailCURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525001/12/201704/01/2017 10/01/202410/01/2024
Contract DetailWALGREEN CO.WALGREENS #19147 162 OCILLA HWY
STE C
FITZGERALDGA3175007/10/201810/01/2018 02/20/202304/03/2023
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC00836-02ActiveBPS-H80-017774SOUTH CENTRAL PRIMARY CARE CENTERSouth Central Family Medicine640 Main St N PearsonGA
CHC00836-03ActiveBPS-H80-008608SOUTH CENTRAL PRIMARY CARE CENTERSouth Central Family Health Care607 C. N. Irwin Ave. OcillaGA
CHC00836-04TerminatedBPS-H80-013002SOUTH CENTRAL PRIMARY CARE CENTERKid's Health119 Norman Dorminy Drive, Suite A FitzgeraldGA
CHC00836-05ActiveBPS-H80-012847SOUTH CENTRAL PRIMARY CARE CENTERSouth Central Primary Care Center, Inc. - Operations Building406 W 5th St OcillaGA
CHC00836-06ActiveBPS-H80-012841SOUTH CENTRAL PRIMARY CARE CENTERKid's Health303 Shirley Ave STE B DouglasGA
CHC00836-07ActiveBPS-H80-014431SOUTH CENTRAL PRIMARY CARE CENTERDouglas Family Health1309 OCILLA RD DOUGLASGA
CHC00836-08TerminatedBPS-H80-013973SOUTH CENTRAL PRIMARY CARE CENTERSouth Central Women's Health119 Norman Dorminy Dr. Suite B FitzgeraldGA
CHC00836-09ActiveBPS-H80-015006SOUTH CENTRAL PRIMARY CARE CENTERBetty Dupree Health Care Center201 N BARTOW ST NASHVILLEGA
CHC00836-10TerminatedBPS-H80-017412SOUTH CENTRAL PRIMARY CARE CENTERKids Health602 N. Irwin Ave. STE B OcillaGA
CHC00836-11ActiveBPS-H80-019544South Central Primary Care Center, Inc.South Central Primary Care Center - Administrative Building204 E. 4th St. OcillaGA
CHC00836-12ActiveBPS-H80-021461South Central Primary Care Center, Inc.Psychiatric and Counseling Services303 Shirley Ave Ste A DouglasGA
CHC00836-13TerminatedBPS-H80-021879South Central Primary Care Center, Inc.Lenox Family Medicine15 S Railroad St LenoxGA
CHC00836-14TerminatedBPS-H80-021573South Central Primary Care Center, Inc.Irwin Family Medicine361 Cargile Rd OcillaGA
CHC00836-15ActiveBPS-H80-022244South Central Primary Care Center, Inc.Northside Family Health Center247-B Northside Drive ValdostaGA
CHC00836-16ActiveBPS-H80-030877South Central Primary Care Center, Inc.Kid's Health - Valdosta2707 N Barack Obama Boulevard ValdostaGA
CHC00836-17TerminatedBPS-H80-033586SOUTH CENTRAL PRIMARY CARE CENTER INCValdosta Internal Medicine3308 Greystone Way ValdostaGA
CHC00836-18ActiveBPS-H80-029635SOUTH CENTRAL PRIMARY CARE CENTER, INC.Kid's Health - IC Schools149 Chieftain Cir OcillaGA
CHC00836-19ActiveBPS-H80-032417SOUTH CENTRAL PRIMARY CARE CENTER, INC.South Central Family Medicine Mobile Unit640 Main St N PearsonGA
CHC00836-20ActiveBPS-H80-035467SOUTH CENTRAL PRIMARY CARE CENTER, INC.Ben Hill County School Health Center134 Jc Hunter Rd FitzgeraldGA
CHC00836-21ActiveBPS-H80-035616SOUTH CENTRAL PRIMARY CARE CENTER, INC.Irwin County School Health Center521 Lax Hwy OcillaGA
CHC00836-22ActiveBPS-H80-035386SOUTH CENTRAL PRIMARY CARE CENTER, INC.Kid's Health - Fitzgerald299 W. Benjamin Hill Dr. FitzgeraldGA
CHC00836-23ActiveBPS-H80-037966SOUTH CENTRAL PRIMARY CARE CENTER, INC.Valdosta Children's Healthcare105 W Cranford Ave ValdostaGA
CHC00836-24ActiveBPS-H80-037298SOUTH CENTRAL PRIMARY CARE CENTER, INC.South Central Primary Care - Ashley Street2301 N Ashley St ValdostaGA
CHC00836-25TerminatedBPS-H80-017774SOUTH CENTRAL PRIMARY CARE CENTER, INC.SOUTH CENTRAL FAMILY MEDICINE640 Main St N PearsonGA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC00836-11A & H DRUG, LLCWILLS DRUG CO 615 N IRWIN AVE
THE MEDICINE CABINET OF OCILLA
OCILLAGA31774-500907/01/2021  
CHC00836-11AHSSHCEXPEDIEN RX PHARMACY 5050 WESLEY RD STE 120
APOPKAFL3271201/01/2019  
CHC00836-05APPALACHIAN SPECIALTY PHARMACY932 HENDERSONVILLE RD STE 106
ASHEVILLENC28803-661907/01/2021 09/23/2024
CHC00836-11AVELLA OF DEER VALLEY, INC. #38DBA AVELLA SPECIALTY PHARMACY 24416 N. 19TH AVE
PHOENIXAZ8508501/01/2019 03/01/2024
CHC00836-11AVELLA OF ORLANDO100 TECHNOLOGY PARK STE 155
LAKE MARYFL32746-620501/01/2019 03/01/2024
CHC00836-11COLONY DISCOUNT DRUGS INC502 S GRANT ST
FITZGERALDGA3175007/01/2021  
CHC00836-04CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371604/01/2017 10/01/2024
CHC00836-03CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371604/01/2017 12/13/2024
CHC00836-06CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371604/01/2017 12/13/2024
CHC00836-05CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371604/01/2017 09/17/2024
CHC00836-08CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371604/01/2017 10/01/2024
CHC00836-07CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371604/01/2017 09/17/2024
CHC00836-09CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371604/01/2017 09/17/2024
CHC00836-10CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371604/01/2017 04/01/2022
CHC00836-04CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525004/01/2017 10/01/2024
CHC00836-03CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525004/01/2017 12/13/2024
CHC00836-06CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525004/01/2017 12/13/2024
CHC00836-05CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525004/01/2017 09/17/2024
CHC00836-08CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525004/01/2017 10/01/2024
CHC00836-07CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525004/01/2017 09/17/2024
CHC00836-09CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525004/01/2017 09/17/2024
CHC00836-10CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525004/01/2017 04/01/2022
CHC00836-11DOGWOOD PHARMACY, LLC501 N DAVIS ST
NASHVILLEGA3163907/01/2021  
CHC00836-11LINDSEY'S HOMETOWN PHARMACY, LLCD/B/A HOMETOWN PHARMACY 407 E MCPHERSON AVE
NASHVILLEGA3163907/01/2021  
CHC00836-11M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312601/01/2019  
CHC00836-11MORRIS DRUG COMPANY646 MAIN ST N
PEARSONGA3164207/01/2021  
CHC00836-05OCILLA PHARMACY, INC.515 N IRWIN AVE
OCILLAGA31774-500707/01/2021  
CHC00836-11OCILLA PHARMACY, INC.515 N IRWIN AVE
OCILLAGA31774-500712/21/2021  
CHC00836-11PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310101/01/2019  
CHC00836-05WALGREEN CODBA: WALGREENS #11661 602 PETERSON AVE S
DOUGLASGA3153307/01/2015  
CHC00836-12WALGREEN CODBA: WALGREENS #11661 602 PETERSON AVE S
DOUGLASGA3153310/01/2018  
CHC00836-09WALGREEN CO.DBA: WALGREENS #18291 402 S DAVIS ST
NASHVILLEGA3163910/01/2018  
CHC00836-03WALGREEN CO.WALGREENS #19147 162 OCILLA HWY
STE C
FITZGERALDGA3175010/01/2018 02/20/2023
CHC00836-04WALGREEN CO.WALGREENS #19147 162 OCILLA HWY
STE C
FITZGERALDGA3175010/01/2018 02/20/2023
CHC00836-08WALGREEN CO.WALGREENS #19147 162 OCILLA HWY
STE C
FITZGERALDGA3175010/01/2018 02/20/2023
CHC00836-14WALGREEN CO.WALGREENS #19147 162 OCILLA HWY
STE C
FITZGERALDGA3175010/01/2018 04/01/2022
CHC00836-10WALGREEN CO.WALGREENS #19147 162 OCILLA HWY
STE C
FITZGERALDGA3175010/01/2018 04/01/2022
CHC00836-03WALGREEN CO.DBA: WALGREENS #18291 402 S DAVIS ST
NASHVILLEGA3163904/01/2020  
CHC00836-07WALGREEN CO.DBA: WALGREENS #18291 402 S DAVIS ST
NASHVILLEGA3163904/01/2020  
CHC00836-15WALGREEN CO.DBA: WALGREENS # 06899 2815 N ASHLEY STREET
VALDOSTAGA31602-180604/01/2020  
CHC00836-05WALGREEN CO.WALGREENS #19147 162 OCILLA HWY
STE C
FITZGERALDGA3175004/01/2020 03/21/2023
CHC00836-05WALGREEN CO.DBA: WALGREENS #18291 402 S DAVIS ST
NASHVILLEGA3163904/01/2020  
CHC00836-05WALGREEN CO.DBA: WALGREENS # 06899 2815 N ASHLEY STREET
VALDOSTAGA31602-180604/01/2020  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated10/1/2024 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 8/1/2024 12:00:00 AM8/2/2024 11:48 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated8/2/2024 11:48 AM
TerminationsTermination CommentsUpdateTermination Request Hospitals in our area discontinued their delivery departments. Nearest hospital was too far away for our provider to continue to operate as a Ob physician out of this office. 8/2/2024 11:48 AM
TerminationsTermination DateUpdateTermination Request 10/1/2024 12:00:00 AM8/2/2024 11:48 AM
TerminationsTermination Effective DateUpdateTermination Request 8/1/2024 12:00:00 AM8/2/2024 11:48 AM
TerminationsTermination ReasonUpdateTermination Request Business decision by the Covered Entity8/2/2024 11:48 AM
DetailsLast Recertification DateUpdateRecertification2/6/2023 9:10:31 AM1/29/2024 9:54:30 AM1/29/2024 9:54 AM
ContactsPrimary ContactUpdateNew RegistrationSwanson, Judy Quality Coordinator South Central Primary Care Center, Inc. 2294689166Swanson, Judy Nurse Manager South Central Primary Care Center, Inc. 22946891664/3/2023 9:16 AM
DetailsLast Recertification DateUpdateRecertification1/31/2022 2:21:29 PM2/6/2023 9:10:31 AM2/6/2023 9:10 AM
DetailsLast Recertification DateUpdateRecertification2/4/2021 8:43:07 AM1/31/2022 2:21:29 PM1/31/2022 2:21 PM
DetailsLast Recertification DateUpdateRecertification1/28/2020 3:23:18 PM2/4/2021 8:43:07 AM2/4/2021 8:43 AM
DetailsLast Recertification DateUpdateRecertification1/29/2019 11:52:13 AM1/28/2020 3:23:18 PM1/28/2020 3:23 PM
DetailsLast Recertification DateUpdateRecertification2/7/2018 8:31:40 AM1/29/2019 11:52:13 AM1/29/2019 11:52 AM
ContactsPrimary ContactUpdateRecertificationTucker, Robert B. CEO South Central Primary Care Center, Inc. 2294689166-1Swanson, Judy Quality Coordinator South Central Primary Care Center, Inc. 22946891662/7/2018 8:31 AM
DetailsLast Recertification DateUpdateRecertification2/17/2017 12:00:00 AM2/7/2018 8:31:40 AM2/7/2018 8:31 AM
DetailsIs Authorizing Official EHB DataUpdateRecertificationFalse 2/7/2018 8:31 AM
ContactsAuthorizing OfficialUpdate Tucker, Robert B. CEO 2294689166-1Tucker, Robert B. CEO South Central Primary Care Center, Inc. 2294689166-11/25/2018 10:25 AM
ContactsPrimary ContactUpdate Tucker, Robert B. CEO 2294689166-1Tucker, Robert B. CEO South Central Primary Care Center, Inc. 2294689166-11/25/2018 10:25 AM
ContactsSigned ByUpdate Tucker, Robert B. CEO 2294689166-1Tucker, Robert B. CEO South Central Primary Care Center, Inc. 2294689166-11/25/2018 10:25 AM
ContactsAuthorizing OfficialInsert  Tucker, Robert B. CEO 2294689166-12/17/2017 7:51 AM
ContactsPrimary ContactInsert  Tucker, Robert B. CEO 2294689166-12/17/2017 7:51 AM
ContactsSigned ByInsert  Tucker, Robert B. CEO 2294689166-12/17/2017 7:51 AM
AddressesMain AddressInsert   119 Norman Dorminy Dr. Suite B Fitzgerald, GA 31750-88552/17/2017 7:50 AM
DetailsLast Recertification DateUpdate 3/1/2016 12:00:00 AM2/17/2017 12:00:00 AM2/17/2017 7:50 AM
DetailsLast Recertification DateUpdate  3/1/2016 12:00:00 AM3/1/2016 11:10 AM
DatesParticipating Approval DateUpdate  1/22/2015 12:00:00 AM1/22/2015 5:54 PM
DetailsStateUpdate PendingActive1/22/2015 5:54 PM
DatesStart DateUpdate  4/1/2015 12:00:00 AM1/22/2015 5:54 PM
Details340B IDUpdate ONLINE_REG_49818CHC00836-081/20/2015 1:55 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_498181/15/2015 1:53 PM
DetailsLast Recertification DateInsert   1/15/2015 1:53 PM
DetailsGrant NumberInsert  H80CS008361/15/2015 1:53 PM
Details340B IDInsert  ONLINE_REG1/15/2015 1:53 PM
DetailsIs Authorizing Official EHB DataInsert  False1/15/2015 1:53 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/15/2015 1:53 PM
DetailsMedicare Provider NumberInsert   1/15/2015 1:53 PM
DetailsEntity NameInsert  SOUTH CENTRAL PRIMARY CARE CENTER1/15/2015 1:53 PM
DetailsProgram CodeInsert  CH1/15/2015 1:53 PM
DetailsEntity SubnameInsert  South Central Women's Health1/15/2015 1:53 PM
DatesParticipating Approval DateInsert   1/15/2015 1:53 PM
DetailsStateInsert  Pending1/15/2015 1:53 PM
DatesRegistration DateInsert  1/15/2015 12:00:00 AM1/15/2015 1:53 PM
DatesSigned By DateInsert  1/15/2015 12:00:00 AM1/15/2015 1:53 PM
DatesStart DateInsert   1/15/2015 1:53 PM
TerminationsTermination CommentsInsert   1/15/2015 1:53 PM
TerminationsTermination DateInsert   1/15/2015 1:53 PM
TerminationsTermination Effective DateInsert   1/15/2015 1:53 PM
TerminationsTermination ReasonInsert   1/15/2015 1:53 PM