Covered Entity Details

CH03074T ST CHARLES HEALTH COUNCIL INC (Active) - information as of 4/29/2025 11:53:51 PM

Main Details

Name

ST CHARLES HEALTH COUNCIL INC

Subdivision Name

Jonesville Family Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-017461

340B ID

CH03074T

Grant Number

H80CS00604

Additional Details

Current Program Status

Active

Registration Date

1/15/2016

Participating Start Date

4/1/2016

Participating Approval Date

2/10/2016

Last Recertification Date

2/13/2025

Contacts

Authorizing Official

St Charles Health Council, Inc
MALCOLM PERDUE, CEO
(276) 546-5310

Primary Contact

St. Charles Health Council, Inc. d/b/a Stone Mountain Health Services
Saundra Jones, COO
(276) 546-5310 Ext: 3102

Addresses

Street Address

276 Fieldstone Drive
Jonesville, VA 24263

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
KY	64036072	1740252501
TN	Q047757	1740252501
VA	007603011	1295857993

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.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH030740	Active	BPS-H80-002140	ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES		241 MONARCH RD		ST CHARLES	VA
CH03074A	Terminated	BPS-H80-004572	ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES		185 REDWOOD AVE	SUITE 102	PENNINGTON GAP	VA
CH03074B	Active	BPS-H80-001751	ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES	THOMPSON FAMILY HEALTH CENTER	1721 LOVERS GAP RD		VANSANT	VA
CH03074C	Active	BPS-H80-003478	ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES	HAYSI CLINIC	162 MEDICAL CENTER BLVD.		HAYSI	VA
CH03074D	Terminated	BPS-H80-001503	ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES	DAVENPORT CLINIC	3837 HELEN HENDERSON HWY		DAVENPORT	VA
CH03074F	Terminated	BPS-H80-004993	ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES	PENNINGTON FAMILY HEALTH CLINIC	127 HEALTH CARE DR.	SUITE 12	PENNINGTON GAP	VA
CH03074I	Active	BPS-H80-005414	ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES	WESTERN LEE COUNTY HEALTH CENTER	1446 DR. THOMAS WALKER RD		EWING	VA
CH03074J	Active	BPS-H80-003304	ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES	WILLIAM A. DAVIS CLINIC	1389 DANTE RD		ST. PAUL	VA
CH03074K	Active	BPS-H80-004396	ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES	HOLSTON FAMILY HEALTH CENTER	306 SOUTH SHADY AVENUE		DAMASCUS	VA
CH03074M	Active	BPS-H80-004532	ST CHARLES HEALTH COUNCIL INC	KONNAROCK FAMILY HEALTH CENTER	20471 Azen Rd		Damascus	VA
CH03074R	Active	BPS-H80-020965	ST CHARLES HEALTH COUNCIL INC	Appalachia Family Health Center	536 East Main Street		Appalachia	VA
CH03074S	Active	BPS-H80-002035	ST CHARLES HEALTH COUNCIL INC	Hurley Family Health Center	10279 Hurley Road		Hurley	VA
CH03074T	Active	BPS-H80-017461	ST CHARLES HEALTH COUNCIL INC	Jonesville Family Health Center	276 Fieldstone Drive		Jonesville	VA
CH03074U	Active	BPS-H80-018597	ST CHARLES HEALTH COUNCIL INC	Council Family Health Center	4124 Council Mountain Road		Honaker	VA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH030740	CORNERSTONE PHARMACY	205 KILBOURNE AVE.		APPALACHIA	VA	24216	10/01/2018
CH030740	ERNIE'S DRUG INC	16408 WISE ST		SAINT PAUL	VA	24283-3543	10/01/2017	08/05/2021
CH030740	FAMILY DRUG	1755 LOVERS GAP RD		VANSANT	VA	24656-9781	10/01/2017	03/31/2019
CH030740	FAMILY DRUG INC	14 E 27TH ST N STE 1		BIG STONE GAP	VA	24219-3624	01/01/2019
CH030740	FOOD CITY PHARMACY #839	18765 RIVERSIDE DRIVE	P.O. BOX 799	VANSANT	VA	24656	10/01/2017
CH030740	FOOD CITY PHARMACY #860	736 NORTH BEAVER DAM ROAD		DAMASCUS	VA	24236	10/01/2017
CH030740	FOOD CITY PHARMACY #891	603 WOOD AVENUE E		BIG STONE GAP	VA	24219	10/01/2017
CH030740	FOOD CITY PHARMACY #895	205 RIVERBEND DRIVE	SUITE 102	PENNINGTON GAP	VA	24277	10/01/2017
CH030740	HAYSI DRUG CENTER	23906 DICKENSON HWY		HAYSI	VA	24256-5992	10/01/2017	03/31/2019
CH030740	HURLEY COMMUNITY PHARMACY	10249 HURLEY ROAD	P O BOX 477	HURLEY	VA	24620	10/01/2017
CH030740	JONES & COUNTS PHARMACY	PO BOX 99	164 HAYSI MAIN STREET	HAYSI	VA	24256	10/01/2017	03/01/2022
CH030740	JONESVILLE DRUG CO INC	154 CHAPPELL DR		JONESVILLE	VA	24263	10/01/2017
CH030740	LAUREL FAMILY DRUG	204 S SHADY AVE	PO BOX 69	DAMASCUS	VA	24236	10/01/2017
CH030740	MEDICAL PARK PHARMACY	1503 SLATE CREEK RD		GRUNDY	VA	24614	10/01/2017
CH030740	PENNINGTON DRUG CENTER	DBA PENNINGTON PHARMACY	41692 WEST MORGAN AVENUE	PENNINGTON GAP	VA	24277	10/01/2017
CH030740	RITE AID OF VIRGINIA, INC.	RITE AID #2497	20822 RIVERSIDE DRIVE	GRUNDY	VA	24614	07/01/2017	12/15/2017
CH030740	RITE AID OF VIRGINIA, INC.	RITE AID #3271	5261 HIGHWAY 421	PENNINGTON GAP	VA	24277	07/01/2017	12/15/2017
CH030740	RITE AID OF VIRGINIA, INC.	RITE AID #1396	5451 DICKENSON HWY	CLINTWOOD	VA	24228-7182	07/01/2017	12/15/2017
CH030740	RITE AID OF VIRGINIA, INC.	RITE AID #1636	16435 WISE STREET P.O. BOX 980	ST PAUL	VA	24283	07/01/2017	12/15/2017
CH030740	ROSE HILL PHARMACY	5462 DR THOMAS WALKER RD		ROSE HILL	VA	24281	10/01/2017
CH030740	UNION DRUG INC.	310 CLOVERLEAF SQUARE BUILDING A SUITE 1		BIG STONE GAP	VA	24219	01/01/2019	04/01/2020
CH030740	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH030740	WAL-MART PHARMACY 10-0739	US HWY 441 HWY 25E		MIDDLESBORO	KY	40965	07/01/2017
CH030740	WAL-MART PHARMACY 10-1302	780 COMMONWEALTH DRIVE		NORTON	VA	24273	10/01/2018
CH030740	WAL-MART PHARMACY 10-2761	13320 G.C. PEERY HIGHWAY		POUNDING MILL	VA	24637	07/01/2017	09/05/2023
CH030740	WAL-MART PHARMACY 10-3303	1179 RIVERVIEW STREET		GRUNDY	VA	24614	07/01/2017
CH030740	WAL-MART PHARMACY 10-3480	1050 REGIONAL PARK ROAD		LEBANON	VA	24266	07/01/2017
CH030740	WAL-MART PHARMACY 10-3772	468 TRADE CENTER LANE		JONESVILLE	VA	24263	07/01/2017
CH030740	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH030740	WALGREEN CO DBA WALGREENS #17431	DBA WALGREENS #17431	3059 HALF AVE	SAINT PAUL	VA	24283	10/01/2023
CH030740	WALGREEN CO.	DBA: WALGREENS # 05347	2412 W. STATE STREET	BRISTOL	TN	37620	04/01/2016
CH030740	WALGREEN CO.	DBA: WALGREENS # 05828	1420 W STONE DR	KINGSPORT	TN	37660	04/01/2016
CH030740	WALGREEN CO.	DBA: WALGREENS # 09046	1560 LEE HWY	BRISTOL	VA	24201	04/01/2016
CH030740	WALGREEN CO.	DBA: WALGREENS # 09428	4500 W STONE DRIVE	KINGSPORT	TN	37660	04/01/2016
CH030740	WALGREEN CO.	DBA: WALGREENS #09948	668 W. MAIN ST.	ABINGDON	VA	24210-2510	04/01/2016
CH030740	WALGREEN CO.	DBA: WALGREENS #10192	1388 VOLUNTEER PKWY.	BRISTOL	TN	37620-5700	04/01/2016
CH030740	WALGREEN CO.	DBA: WALGREENS #10700	1102 N. MAIN ST.	MARION	VA	24354-4122	04/01/2016
CH030740	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13979	1 MEDICAL PARK BLVD, STE 106E	BRISTOL	TN	37620	04/01/2016
CH030740	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13980	130 W. RAVINE STE #101	KINGSPORT	TN	37660	04/01/2016
CH030740	WALGREEN CO.	DBA: BROADWATER DRUG #15669	POWERED BY WALGREENS 119 E. JACKSON ST., SUITE 101	GATE CITY	VA	24251	04/01/2016
CH030740	WALGREEN CO.	WALGREENS #17606	16435 WISE ST	SAINT PAUL	VA	24283-0980	12/28/2017	01/25/2023
CH030740	WALGREEN CO.	WALGREENS #17306	20822 RIVERSIDE DR	GRUNDY	VA	24614-9597	12/28/2017	01/23/2025
CH030740	WALGREEN CO.	WALGREENS #19095	5261 US HIGHWAY 421	PENNINGTON GAP	VA	24277-2261	12/28/2017
CH030740	WALGREEN CO.	WALGREENS #17334	5419 DICKENSON HWY	CLINTWOOD	VA	24228-7182	12/28/2017
CH030740	WALGREEN CO.	WALGREENS #17546	101 LAUREL AVE PO BOX 2043	COEBURN	VA	24230-2043	07/01/2019	11/08/2022
CH030740	WALGREEN CO.	WALGREENS #17362	1005 E MAIN ST	LEBANON	VA	24266	07/01/2019
CH030740	WALGREEN CO.	DBA: WALGREENS #17991	1267 MAIN STREET P.O. BOX 95	SNEEDVILLE	TN	37869	07/01/2019	11/07/2022
CH030740	Walgreens #21420	Walgreens Central Fill #21420	8440 Times Dispatch Blvd Ste. 400	Mechanicsville	VA	23116	10/01/2023
CH030740	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2016
CH030740	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2018	02/10/2025
CH030740	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2018
CH030740	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024
CH030740	WEST END PHARMACY	340 COLLEY SHOPPING CTR		CLINTWOOD	VA	24228	10/01/2017

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/31/2024 9:15:40 AM	2/13/2025 7:20:42 AM	2/13/2025 7:20 AM
Details	Last Recertification Date	Update	Recertification	2/6/2023 11:49:42 AM	1/31/2024 9:15:40 AM	1/31/2024 9:15 AM
Details	Last Recertification Date	Update	Recertification	2/3/2022 10:06:48 AM	2/6/2023 11:49:42 AM	2/6/2023 11:49 AM
Details	Last Recertification Date	Update	Recertification	2/11/2021 4:30:09 PM	2/3/2022 10:06:48 AM	2/3/2022 10:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/11/2021 4:30 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		64036072	2/11/2021 4:30 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		KY	2/11/2021 4:30 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/11/2021 4:30 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		Q047757	2/11/2021 4:30 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		TN	2/11/2021 4:30 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1295857993 ( )		2/11/2021 4:30 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1295857993	2/11/2021 4:30 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	2/11/2021 4:30 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740252501	2/11/2021 4:30 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	2/11/2021 4:30 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740252501	2/11/2021 4:30 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	2/11/2021 4:30 PM
Details	Last Recertification Date	Update	Recertification	1/28/2020 9:52:25 AM	2/11/2021 4:30:09 PM	2/11/2021 4:30 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	1295857993	007603011	5/12/2020 9:32 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 10:19:52 AM	1/28/2020 9:52:25 AM	1/28/2020 9:52 AM
Details	Last Recertification Date	Update	Recertification	2/7/2018 1:36:27 PM	1/29/2019 10:19:52 AM	1/29/2019 10:19 AM
Contacts	Primary Contact	Update	Recertification	PERDUE, MALCOLM CEO St Charles Health Council, Inc 2765465310	Jones, Saundra COO St. Charles Health Council, Inc. d/b/a Stone Mountain Health Services 2765465310-3102	2/7/2018 1:36 PM
Details	Last Recertification Date	Update	Recertification	2/13/2017 12:00:00 AM	2/7/2018 1:36:27 PM	2/7/2018 1:36 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/7/2018 1:36 PM
Contacts	Authorizing Official	Update		PERDUE, MALCOLM CEO 2765465310	PERDUE, MALCOLM CEO St Charles Health Council, Inc 2765465310	10/10/2017 9:11 AM
Contacts	Primary Contact	Update		PERDUE, MALCOLM CEO 2765465310	PERDUE, MALCOLM CEO St Charles Health Council, Inc 2765465310	10/10/2017 9:11 AM
Contacts	Signed By	Update		PERDUE, MALCOLM CEO 2765465310	PERDUE, MALCOLM CEO St Charles Health Council, Inc 2765465310	10/10/2017 9:11 AM
Contacts	Authorizing Official	Insert			PERDUE, MALCOLM CEO 2765465310	7/14/2017 4:30 PM
Contacts	Primary Contact	Insert			PERDUE, MALCOLM CEO 2765465310	7/14/2017 4:30 PM
Contacts	Signed By	Insert			PERDUE, MALCOLM CEO 2765465310	7/14/2017 4:30 PM
Addresses	Main Address	Insert			276 Fieldstone Drive Jonesville, VA 24263	2/13/2017 2:20 PM
Details	Last Recertification Date	Update			2/13/2017 12:00:00 AM	2/13/2017 2:20 PM
Dates	Participating Approval Date	Update			2/10/2016 12:00:00 AM	2/10/2016 5:06 PM
Details	State	Update		Pending	Active	2/10/2016 5:06 PM
Dates	Start Date	Update			4/1/2016 12:00:00 AM	2/10/2016 5:06 PM
Details	340B ID	Update		ONLINE_REG_58252	CH03074T	1/28/2016 8:08 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_58252	1/15/2016 12:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/15/2016 12:35 PM
Medicaid Billing	Medicaid: Number	Insert			1295857993	1/15/2016 12:35 PM
Medicaid Billing	Medicaid: State	Insert			VA	1/15/2016 12:35 PM
Medicaid Billing	NPI: Number	Insert			1295857993	1/15/2016 12:35 PM
Details	Last Recertification Date	Insert				1/15/2016 12:35 PM
Details	Grant Number	Insert			H80CS00604	1/15/2016 12:35 PM
Details	340B ID	Insert			ONLINE_REG	1/15/2016 12:35 PM
Details	Is Authorizing Official EHB Data	Insert			False	1/15/2016 12:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/15/2016 12:35 PM
Details	Medicare Provider Number	Insert				1/15/2016 12:35 PM
Details	Entity Name	Insert			ST CHARLES HEALTH COUNCIL INC	1/15/2016 12:35 PM
Details	Program Code	Insert			CH	1/15/2016 12:35 PM
Details	Entity Subname	Insert			Jonesville Family Health Center	1/15/2016 12:35 PM
Dates	Participating Approval Date	Insert				1/15/2016 12:35 PM
Details	State	Insert			Pending	1/15/2016 12:35 PM
Dates	Registration Date	Insert			1/15/2016 12:00:00 AM	1/15/2016 12:35 PM
Dates	Signed By Date	Insert			1/15/2016 12:00:00 AM	1/15/2016 12:35 PM
Dates	Start Date	Insert				1/15/2016 12:35 PM
Terminations	Termination Comments	Insert				1/15/2016 12:35 PM
Terminations	Termination Date	Insert				1/15/2016 12:35 PM
Terminations	Termination Effective Date	Insert				1/15/2016 12:35 PM
Terminations	Termination Reason	Insert				1/15/2016 12:35 PM

340B Drug Pricing Program Database