Covered Entity Details

CAH111320-01 HIGGINS GENERAL HOSPITAL (Active) - information as of 4/27/2025 10:48:01 PM

Main Details

Name

HIGGINS GENERAL HOSPITAL

Subdivision Name

Buchanan Medical Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH111320-01

Medicare Provider Number

111320

Outpatient Facility Provider Number

118549

Additional Details

Current Program Status

Active

Registration Date

1/11/2016

Participating Start Date

4/1/2016

Participating Approval Date

2/12/2016

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

Tanner Health System
Carol S. Crews, CFO
(770) 812-9745

Primary Contact

Tanner Health System
Emily Renee Allen, 340B Program Manager
(770) 812-8371

Addresses

Street Address

2908 US Highway 27
Buchanan, GA 30113

Billing Address

Buchanan Family Healthcare
ATTN: ACCOUNTS PAYABLE
100 Greenway Blvd
Suite A
Carrollton, GA 30117

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?
Yes

State	Medicaid Number	NPI Number
GA	003157199A	1508801416

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
CAH111320-01	Child	CAH	HIGGINS GENERAL HOSPITAL	Buchanan Medical Clinic	2908 US Highway 27	Buchanan	GA	Active
CAH111320-02	Child	CAH	HIGGINS GENERAL HOSPITAL	Tallapoosa Family Healthcare	25 W Lyon Street	Tallapoosa	GA	Active
CAH111320-03	Child	CAH	HIGGINS GENERAL HOSPITAL	Primary Care of Bremen	204 Allen Memorial Drive, Ste 201	Bremen	GA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	PC Change Request	Miller, Emily 340B Program Manager Tanner Health System 7708128371	Allen, Emily Renee 340B Program Manager Tanner Health System 7708128371	2/7/2025 2:02 PM
Addresses	Billing Address	Update	Recertification	Buchanan Family Healthcare ATTN: ACCOUNTS PAYABLE 109 Cedar Street Suite A Carrollton, GA 30117	Buchanan Family Healthcare ATTN: ACCOUNTS PAYABLE 100 Greenway Blvd Suite A Carrollton, GA 30117	8/29/2024 4:29 PM
Details	Last Recertification Date	Update	Recertification	8/21/2023 11:03:38 AM	8/29/2024 4:29:07 PM	8/29/2024 4:29 PM
Contacts	Primary Contact	Update	Group Change Request	Barrett, Lynn Director of Pharmacy Tanner Medical Center 7708369646	Miller, Emily 340B Program Manager Tanner Health System 7708128371	3/14/2024 3:30 PM
Addresses	Main Address	Update	Recertification	30 Buchanan Bypass Buchanan, GA 30113	2908 US Highway 27 Buchanan, GA 30113	8/21/2023 11:03 AM
Details	Last Recertification Date	Update	Recertification	9/5/2022 8:35:50 PM	8/21/2023 11:03:38 AM	8/21/2023 11:03 AM
Details	Last Recertification Date	Update	Recertification	8/30/2021 12:11:47 PM	9/5/2022 8:35:50 PM	9/5/2022 8:35 PM
Details	Last Recertification Date	Update	Recertification	8/24/2020 12:40:51 AM	8/30/2021 12:11:47 PM	8/30/2021 12:11 PM
Medicaid Billing	NPI: State	Update	Recertification		GA	8/24/2020 12:40 AM
Details	Last Recertification Date	Update	Recertification	9/1/2019 6:22:17 PM	8/24/2020 12:40:51 AM	8/24/2020 12:40 AM
Details	Last Recertification Date	Update	Recertification	8/27/2018 8:35:05 AM	9/1/2019 6:22:17 PM	9/1/2019 6:22 PM
Addresses	Billing Address	Insert	Recertification		Buchanan Family Healthcare ATTN: ACCOUNTS PAYABLE 109 Cedar Street Suite A Carrollton, GA 30117	8/27/2018 8:35 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/27/2018 8:35 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		003157199A	8/27/2018 8:35 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	8/27/2018 8:35 AM
Details	Last Recertification Date	Update	Recertification	12/3/2017 9:29:18 PM	8/27/2018 8:35:05 AM	8/27/2018 8:35 AM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	12/3/2017 9:29:18 PM	12/3/2017 9:29 PM
Contacts	Authorizing Official	Update		Crews, Carol S. CFO 7708129745	Crews, Carol S. CFO Tanner Health System 7708129745	10/11/2017 2:57 PM
Contacts	Signed By	Update		Crews, Carol S. CFO 7708129745	Crews, Carol S. CFO Tanner Health System 7708129745	10/11/2017 2:57 PM
Contacts	Primary Contact	Update		Barrett, Lynn Director of Pharmacy 7708369646	Barrett, Lynn Director of Pharmacy Tanner Medical Center 7708369646	9/29/2017 9:16 AM
Contacts	Primary Contact	Insert			Barrett, Lynn Director of Pharmacy 7708369646	2/21/2017 1:47 PM
Contacts	Authorizing Official	Insert			Crews, Carol S. CFO 7708129745	2/21/2017 1:47 PM
Contacts	Signed By	Insert			Crews, Carol S. CFO 7708129745	2/21/2017 1:47 PM
Addresses	Main Address	Insert			30 Buchanan Bypass Buchanan, GA 30113	8/29/2016 6:10 PM
Details	Last Recertification Date	Update			8/29/2016 12:00:00 AM	8/29/2016 6:10 PM
Dates	Participating Approval Date	Update			2/12/2016 12:00:00 AM	2/12/2016 3:49 PM
Details	State	Update		Pending	Active	2/12/2016 3:49 PM
Dates	Start Date	Update			4/1/2016 12:00:00 AM	2/12/2016 3:49 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_57059	CAH111320-01	1/12/2016 8:29 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_57059	1/11/2016 3:40 PM
Medicaid Billing	NPI: Number	Insert			1508801416	1/11/2016 3:40 PM
Details	Last Recertification Date	Insert				1/11/2016 3:40 PM
Details	Grant Number	Insert				1/11/2016 3:40 PM
Details	340B ID	Insert				1/11/2016 3:40 PM
Details	Is Authorizing Official EHB Data	Insert				1/11/2016 3:40 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/11/2016 3:40 PM
Details	Medicare Provider Number	Insert			111320	1/11/2016 3:40 PM
Details	Entity Name	Insert			HIGGINS GENERAL HOSPITAL	1/11/2016 3:40 PM
Details	Program Code	Insert			CAH	1/11/2016 3:40 PM
Details	Entity Subname	Insert			Buchanan Medical Clinic	1/11/2016 3:40 PM
Dates	Participating Approval Date	Insert				1/11/2016 3:40 PM
Details	State	Insert			Pending	1/11/2016 3:40 PM
Dates	Registration Date	Insert			1/11/2016 12:00:00 AM	1/11/2016 3:40 PM
Dates	Signed By Date	Insert			1/11/2016 12:00:00 AM	1/11/2016 3:40 PM
Dates	Start Date	Insert				1/11/2016 3:40 PM
Terminations	Termination Comments	Insert				1/11/2016 3:40 PM
Terminations	Termination Date	Insert				1/11/2016 3:40 PM
Terminations	Termination Effective Date	Insert				1/11/2016 3:40 PM
Terminations	Termination Reason	Insert				1/11/2016 3:40 PM