340B Drug Pricing Program Database


CH04743E GEORGIA HIGHLANDS MEDICAL SERVICES, INC. (Active) - information as of 4/24/2025 11:58:02 PM

Main Details
GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
GHMS Dawsonville Family Health Center
HRSA-Funded Health Center
BPS-H80-019133
CH04743E
H80CS00470


Additional Details
Active
4/10/2017
7/1/2017
4/18/2017
2/12/2025

Contacts

Georgia Highlands Medical Services
Todd Shifflet, CEO
(770) 887-1668 Ext: 1102

Georgia Highlands Medical Services, Inc
Jessica Pulliam, Pharmacist
(770) 887-1670

Addresses

5959 Highway 53 E Ste 100
Dawsonville, GA 30534-8353

Georgia Highlands Medical Services, INC.
475 Tribble Gap Road
Cumming, GA 30040


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

Yes
StateMedicaid NumberNPI Number
GA000192574C,003146289A,003183795A,003188430A,003168146A,000192574E,003245090A,003290096A1053702191,1063419422,1124565650,1174529192,1407281058,1407306418,1811501455,1194987412,1427762707
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05640 6327 HWY. 53 EAST
DAWSONVILLEGA3053404/09/202407/01/2024  07/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH047430ActiveBPS-H80-001646GEORGIA HIGHLANDS MEDICAL SERVICES, INC.GHMS Cumming Family Health Center260 Elm St CummingGA
CH04743BActiveBPS-H80-003944GEORGIA HIGHLANDS MEDICAL SERVICES, INC.GHMS Canton Family Health Center220 OAKSIDE LN BLDG CANTONGA
CH04743CActiveBPS-H80-012842GEORGIA HIGHLANDS MEDICAL SERVICES, INC.GHMS Bartow Family Health Center775 West Ave Ste A CartersvilleGA
CH04743DActiveBPS-H80-017102GEORGIA HIGHLANDS MEDICAL SERVICES, INC.Highlands Medical Plaza475 Tribble Gap Rd CummingGA
CH04743EActiveBPS-H80-019133GEORGIA HIGHLANDS MEDICAL SERVICES, INC.GHMS Dawsonville Family Health Center5959 Highway 53 E Ste 100 DawsonvilleGA
CH04743FActiveBPS-H80-031232GEORGIA HIGHLANDS MEDICAL SERVICE INCGHMS Canton Center210 Oakside Ln CantonGA
CH04743GActiveBPS-H80-035763GEORGIA HIGHLANDS MEDICAL SERVICE INCGHMS Cumming Elementary Center540 Dahlonega Street CummingGA
CH04743HActiveBPS-H80-036783GEORGIA HIGHLANDS MEDICAL SERVICE INCGHMS Buford Family Health Center3919 Carter Road STE B BufordGA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH047430ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884901/01/2025  
CH047430ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750201/01/2025  
CH047430ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201001/01/2025  
CH047430ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282201/01/2025  
CH047430ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/01/2025  
CH047430ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349201/01/2025  
CH047430ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280901/01/2025  
CH047430BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526107/01/2019 09/04/2022
CH047430CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/01/2025  
CH047430CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/01/2025  
CH047430CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/01/2025  
CH047430CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/01/2025  
CH047430CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/01/2025  
CH047430CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/01/2025  
CH047430CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/01/2025  
CH047430CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/01/2025  
CH047430CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/01/2025  
CH047430CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/01/2025  
CH047430CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD STE 1400
ST PETERSBURGFL33716-233804/01/2014 02/13/2023
CH047430CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B 		SMYRNAGA30082-525004/01/2014 02/13/2023
CH047430CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870601/01/2022  
CH047430CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005601/01/2022  
CH047430CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/01/2025  
CH047430DOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K 		GREENVILLESC29607-654007/01/2019 09/04/2022
CH047430ECKERD CORPORATIONRITE AID #11739 954 JOE FRANK HARRIS PKWY
CARTERSVILLEGA3012010/01/2017 11/06/2017
CH047430ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111201/01/2025  
CH047430EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313401/01/2025  
CH047430EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607501/01/2025  
CH047430EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801601/01/2025  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05352 4110 PLEASANT HILL RD.
DULUTHGA3009601/01/2022 02/09/2023
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05995 7395 SPOUT SPRINGS RD.
FLOWERY BRANCHGA3054201/01/2022 02/09/2023
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05640 6327 HWY. 53 EAST
DAWSONVILLEGA3053401/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02236 1600 TOWNE LAKE PKWY
WOODSTOCKGA3018901/01/2022 02/09/2023
CH047430GEORGIA CVS PHARMACY, L.L.C.CVS PHARMACY # 16561 3205 WOODWARD CROSSING BLVD
SUITE B 		BUFORDGA3051901/01/2022 02/09/2023
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05692 13 NORTH TENNESSEE ST.
CARTERSVILLEGA3012001/01/2022 05/25/2023
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00191 5510 CASTLEBERRY ROAD
CUMMINGGA3004001/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07273 129 MARIETTA HIGHWAY
CANTONGA3011401/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02539 5740 ATLANTA HIGHWAY
ALPHARETTAGA3000401/01/2022 03/28/2023
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04682 4895 POST RD.
CUMMINGGA3004001/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07736 601 HOWARD SIMMONS RD.
EAST ELLIJAYGA3054001/01/2022 02/09/2023
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03392 266 EAST CHURCH ST
JASPERGA3014301/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03086 1162 WEST AVE.
CARTERSVILLEGA3012001/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05355 603 CANTON HWY.
CUMMINGGA3004001/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.CVS PHARMACY # 17450 5865 SPOUT SPRINGS RD
FLOWERY BRANCHGA3054201/01/2022 02/09/2023
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00279 2605 HAMILTON MILL RD
BUFORDGA3051901/01/2022 02/09/2023
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07888 6120 HICKORY FLAT HWY.
CANTONGA3011501/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08976 965 JOE FRANK HARRIS PKWY SE
CARTERSVILLEGA3012001/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.CVS PHARMACY # 17527 2022 CUMMING HWY
CANTONGA3011501/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05653 1950 BUFORD HWY.
BUFORDGA3051801/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04113 3095 OLD ATLANTA RD.
CUMMINGGA3004107/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05071 3709 THOMPSON BRIDGE RD.
GAINESVILLEGA3050607/01/2022  
CH047430GEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02945 13933 ALPHARETTA HWY.
MILTONGA3000407/01/2023  
CH04743BGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08976 965 JOE FRANK HARRIS PKWY SE
CARTERSVILLEGA3012007/01/2024  
CH04743EGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05640 6327 HWY. 53 EAST
DAWSONVILLEGA3053407/01/2024  
CH04743CGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03086 1162 WEST AVE.
CARTERSVILLEGA3012007/01/2024  
CH04743DGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05355 603 CANTON HWY.
CUMMINGGA3004007/01/2024  
CH04743FGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07273 129 MARIETTA HIGHWAY
CANTONGA3011407/01/2024  
CH04743HGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00191 5510 CASTLEBERRY ROAD
CUMMINGGA3004007/01/2024  
CH04743GGEORGIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04682 4895 POST RD.
CUMMINGGA3004007/01/2024  
CH047430GOODSON DRUG CO116 MAPLE ST
CUMMINGGA3004004/05/2005 03/18/2016
CH047430KROGER DRUGSTORE #4732655 FREEDOM PARKWAY
CUMMINGGA3004110/01/2017 11/01/2018
CH047430KROGER PHARMACY #629125 MAIN STREET MARKET PLACE SE
CARTERSVILLEGA3012110/01/2017 11/01/2018
CH047430PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/01/2025  
CH047430PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920301/01/2025  
CH047430PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/01/2025  
CH047430RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255007/01/2019 09/04/2022
CH047430RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500207/01/2019 09/04/2022
CH047430SOUTHSIDE INFUSION7700 MAIN ST STE 210
HOUSTONTX77030-445704/01/2020 03/28/2022
CH047430SOUTHSIDE MASTER LLCDBA SOUTHSIDE PHARMACY 755 MOUNT VERNON HWY NE
STE 450 		ATLANTAGA30328-429204/01/2020 03/28/2022
CH047430SOUTHSIDE PHARMACY 36330 WEST LOOP S STE 700C
BELLAIRETX77401-292804/01/2020 03/28/2022
CH047430VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01556 1170 EMMET ST N
CHARLOTTESVILLEVA2290301/01/2022 02/09/2023
CH047430VIRGINIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07561 503 MAIN ST.
LOUISAVA2309301/01/2022 02/09/2023
CH047430WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738607/01/2019 04/24/2019
CH047430WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2019  
CH047430WAL-MART PHARMACY 10-0615101 MARKET PLACE BLVD
CARTERSVILLEGA3012101/01/2025  
CH047430WAL-MART PHARMACY 10-08781500 MARKET PLACE BLVD.
CUMMINGGA3004107/01/2019 04/24/2019
CH047430WAL-MART PHARMACY 10-08781500 MARKET PLACE BLVD.
CUMMINGGA3004110/01/2019  
CH047430WAL-MART PHARMACY 10-387498 POWER CENTER DR
DAWSONVILLEGA3053407/01/2019 04/24/2019
CH047430WAL-MART PHARMACY 10-387498 POWER CENTER DR
DAWSONVILLEGA3053410/01/2019  
CH047430WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283707/01/2019 04/24/2019
CH047430WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2019  
CH047430WALGREEN CODBA: WALGREENS #09981 101 PROMINENCE POINT PKWY
CANTONGA30114-900907/01/2013  
CH047430WALGREEN CODBA: WALGREENS #09494 4397 SUDDERTH ROAD
SUGAR HILLGA3051804/01/2017  
CH047430WALGREEN CO.DBA: WALGREENS # 07340 120 MARIETTA HIGHWAY
CANTONGA30114-230307/01/2013  
CH047430WALGREEN CO.DBA: WALGREENS #10423 3290 KEITH BRIDGE RD.
CUMMINGGA30041-393707/01/2013  
CH047430WALGREEN CO.DBA: WALGREENS #15180 101 N TENNESSEE ST
CARTERSVILLEGA3012007/01/2014  
CH047430WALGREEN CO.DBA: WALGREENS # 07946 1650 BUFORD HWY
CUMMINGGA3004107/01/2014  
CH047430WALGREEN CO.RITE AID #11737 2017 MARIETTA HWY
CANTONGA3011407/01/2019 07/16/2019
CH047430WALGREEN CO.WALGREENS #17686 954 JOE FRANK HARRIS PKWY SE
CARTERSVILLEGA3012006/08/2020  
CH047430WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/01/2023 07/29/2024
CH047430WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/01/2023 07/29/2024
CH047430WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/01/2023 07/29/2024
CH047430WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275607/01/2023  
CH047430Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/12/2025 10:49 AM
Medicaid BillingMedicaid: NumberInsertRecertification 003290096A2/12/2025 10:49 AM
Medicaid BillingMedicaid: StateInsertRecertification GA2/12/2025 10:49 AM
DetailsLast Recertification DateUpdateRecertification2/1/2024 6:31:30 AM2/12/2025 10:49:44 AM2/12/2025 10:49 AM
AddressesMain AddressUpdateRecertification 5959 Hwy 53 East, Suite 100 Dawsonville, GA 30534-8353 5959 Highway 53 E Ste 100 Dawsonville, GA 30534-83532/1/2024 6:31 AM
Medicaid BillingNPI: NumberInsertRecertification 11949874122/1/2024 6:31 AM
Medicaid BillingNPI: StateInsertRecertification GA2/1/2024 6:31 AM
Medicaid BillingNPI: NumberInsertRecertification 14277627072/1/2024 6:31 AM
Medicaid BillingNPI: StateInsertRecertification GA2/1/2024 6:31 AM
DetailsLast Recertification DateUpdateRecertification1/31/2023 9:49:51 AM2/1/2024 6:31:30 AM2/1/2024 6:31 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False1/31/2023 9:49 AM
Medicaid BillingMedicaid: NumberInsertRecertification 003245090A1/31/2023 9:49 AM
Medicaid BillingMedicaid: StateInsertRecertification GA1/31/2023 9:49 AM
Medicaid BillingNPI: NumberInsertRecertification 18115014551/31/2023 9:49 AM
Medicaid BillingNPI: StateInsertRecertification GA1/31/2023 9:49 AM
DetailsLast Recertification DateUpdateRecertification2/2/2022 10:20:55 AM1/31/2023 9:49:51 AM1/31/2023 9:49 AM
DetailsLast Recertification DateUpdateRecertification2/1/2021 4:09:58 PM2/2/2022 10:20:55 AM2/2/2022 10:20 AM
Medicaid BillingNPI: NumberDeleteRecertification1174529192 ( ) 2/1/2021 4:09 PM
Medicaid BillingNPI: NumberDeleteRecertification1063419422 ( ) 2/1/2021 4:09 PM
Medicaid BillingNPI: NumberDeleteRecertification1407281058 ( ) 2/1/2021 4:09 PM
Medicaid BillingNPI: NumberDeleteRecertification1407306418 ( ) 2/1/2021 4:09 PM
Medicaid BillingNPI: NumberDeleteRecertification1124565650 ( ) 2/1/2021 4:09 PM
Medicaid BillingNPI: NumberDeleteRecertification1053702191 ( ) 2/1/2021 4:09 PM
Medicaid BillingNPI: NumberInsertRecertification 10537021912/1/2021 4:09 PM
Medicaid BillingNPI: StateInsertRecertification GA2/1/2021 4:09 PM
Medicaid BillingNPI: NumberInsertRecertification 10634194222/1/2021 4:09 PM
Medicaid BillingNPI: StateInsertRecertification GA2/1/2021 4:09 PM
Medicaid BillingNPI: NumberInsertRecertification 11245656502/1/2021 4:09 PM
Medicaid BillingNPI: StateInsertRecertification GA2/1/2021 4:09 PM
Medicaid BillingNPI: NumberInsertRecertification 11745291922/1/2021 4:09 PM
Medicaid BillingNPI: StateInsertRecertification GA2/1/2021 4:09 PM
Medicaid BillingNPI: NumberInsertRecertification 14072810582/1/2021 4:09 PM
Medicaid BillingNPI: StateInsertRecertification GA2/1/2021 4:09 PM
Medicaid BillingNPI: NumberInsertRecertification 14073064182/1/2021 4:09 PM
Medicaid BillingNPI: StateInsertRecertification GA2/1/2021 4:09 PM
DetailsLast Recertification DateUpdateRecertification1/30/2020 8:09:52 AM2/1/2021 4:09:58 PM2/1/2021 4:09 PM
ContactsPrimary ContactUpdateChange RequestMistry, Cheryl Pharmacy Director Georgia Highlands Medical Services,inc. 4702971013Pulliam, Jessica Pharmacist Georgia Highlands Medical Services, Inc 770887167012/7/2020 12:14 PM
ContactsPrimary ContactUpdateNew RegistrationMistry, Cheryl Pharmacy Director Georgia Highlands Medical Services,inc. 4702971013Mistry, Cheryl Pharmacy Director Georgia Highlands Medical Services,inc. 470297101310/5/2020 1:28 PM
Medicaid BillingMedicaid: NumberDeleteRecertification000172574E (GA) 1/30/2020 8:09 AM
DetailsLast Recertification DateUpdateRecertification2/1/2019 9:50:48 AM1/30/2020 8:09:52 AM1/30/2020 8:09 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/16/2019 9:57 AM
Medicaid BillingMedicaid: NumberInsertChange Request 000192574E12/16/2019 9:57 AM
Medicaid BillingMedicaid: StateInsertChange Request GA12/16/2019 9:57 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/5/2019 3:34 PM
Medicaid BillingMedicaid: NumberInsertChange Request 000192574C3/5/2019 3:34 PM
Medicaid BillingMedicaid: StateInsertChange Request GA3/5/2019 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/5/2019 3:34 PM
Medicaid BillingMedicaid: NumberInsertChange Request 000172574E3/5/2019 3:34 PM
Medicaid BillingMedicaid: StateInsertChange Request GA3/5/2019 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/5/2019 3:34 PM
Medicaid BillingMedicaid: NumberInsertChange Request 003146289A3/5/2019 3:34 PM
Medicaid BillingMedicaid: StateInsertChange Request GA3/5/2019 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/5/2019 3:34 PM
Medicaid BillingMedicaid: NumberInsertChange Request 003183795A3/5/2019 3:34 PM
Medicaid BillingMedicaid: StateInsertChange Request GA3/5/2019 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/5/2019 3:34 PM
Medicaid BillingMedicaid: NumberInsertChange Request 003188430A3/5/2019 3:34 PM
Medicaid BillingMedicaid: StateInsertChange Request GA3/5/2019 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/5/2019 3:34 PM
Medicaid BillingMedicaid: NumberInsertChange Request 003168146A3/5/2019 3:34 PM
Medicaid BillingMedicaid: StateInsertChange Request GA3/5/2019 3:34 PM
Medicaid BillingNPI: NumberInsertChange Request 11745291923/5/2019 3:34 PM
Medicaid BillingNPI: NumberInsertChange Request 10634194223/5/2019 3:34 PM
Medicaid BillingNPI: NumberInsertChange Request 14072810583/5/2019 3:34 PM
Medicaid BillingNPI: NumberInsertChange Request 14073064183/5/2019 3:34 PM
Medicaid BillingNPI: NumberInsertChange Request 11245656503/5/2019 3:34 PM
Medicaid BillingNPI: NumberInsertChange Request 10537021913/5/2019 3:34 PM
DetailsLast Recertification DateUpdateRecertification2/9/2018 11:15:51 AM2/1/2019 9:50:48 AM2/1/2019 9:50 AM
AddressesBilling AddressInsertRecertification Georgia Highlands Medical Services, INC. 475 Tribble Gap Road Cumming, GA 300402/9/2018 11:15 AM
DetailsLast Recertification DateUpdateRecertification 2/9/2018 11:15:51 AM2/9/2018 11:15 AM
DetailsIs Authorizing Official EHB DataUpdateChange RequestFalse 11/29/2017 1:00 PM
DetailsEntity NameUpdateChange RequestGEORGIA HIGHLANDS MEDICAL SERVICE INCGEORGIA HIGHLANDS MEDICAL SERVICES, INC.11/29/2017 1:00 PM
ContactsAuthorizing OfficialUpdate Shifflet, Todd CEO 7708871668-1102Shifflet, Todd CEO Georgia Highlands Medical Services 7708871668-110211/2/2017 8:49 AM
ContactsSigned ByUpdate Shifflet, Todd CEO 7708871668-1102Shifflet, Todd CEO Georgia Highlands Medical Services 7708871668-110211/2/2017 8:49 AM
ContactsPrimary ContactUpdate Mistry, Cheryl Pharmacy Director 4702971013Mistry, Cheryl Pharmacy Director Georgia Highlands Medical Services,inc. 470297101310/2/2017 10:40 AM
ContactsAuthorizing OfficialInsert  Shifflet, Todd CEO 7708871668-11027/14/2017 12:35 PM
ContactsSigned ByInsert  Shifflet, Todd CEO 7708871668-11027/14/2017 12:35 PM
ContactsPrimary ContactInsert  Mistry, Cheryl Pharmacy Director 47029710135/26/2017 10:33 AM
AddressesMain AddressInsert   5959 Hwy 53 East, Suite 100 Dawsonville, GA 30534-83535/1/2017 5:55 PM
DatesParticipating Approval DateUpdate  4/18/2017 12:00:00 AM4/18/2017 4:57 PM
DetailsStateUpdate PendingActive4/18/2017 4:57 PM
DatesStart DateUpdate  7/1/2017 12:00:00 AM4/18/2017 4:57 PM
Details340B IDUpdate ONLINE_REG_76306CH04743E 4/11/2017 8:12 AM
Details340B IDUpdate ONLINE_REGONLINE_REG_763064/10/2017 11:43 AM
DetailsLast Recertification DateInsert   4/10/2017 11:43 AM
DetailsGrant NumberInsert  H80CS004704/10/2017 11:43 AM
Details340B IDInsert  ONLINE_REG4/10/2017 11:43 AM
DetailsIs Authorizing Official EHB DataInsert  False4/10/2017 11:43 AM
DatesLast Date That 340B Drugs PurchasedInsert   4/10/2017 11:43 AM
DetailsMedicare Provider NumberInsert   4/10/2017 11:43 AM
DetailsEntity NameInsert  GEORGIA HIGHLANDS MEDICAL SERVICE INC4/10/2017 11:43 AM
DetailsProgram CodeInsert  CH4/10/2017 11:43 AM
DetailsEntity SubnameInsert  GHMS Dawsonville Family Health Center4/10/2017 11:43 AM
DatesParticipating Approval DateInsert   4/10/2017 11:43 AM
DetailsStateInsert  Pending4/10/2017 11:43 AM
DatesRegistration DateInsert  4/10/2017 12:00:00 AM4/10/2017 11:43 AM
DatesSigned By DateInsert  4/10/2017 12:00:00 AM4/10/2017 11:43 AM
DatesStart DateInsert   4/10/2017 11:43 AM
TerminationsTermination CommentsInsert   4/10/2017 11:43 AM
TerminationsTermination DateInsert   4/10/2017 11:43 AM
TerminationsTermination Effective DateInsert   4/10/2017 11:43 AM
TerminationsTermination ReasonInsert   4/10/2017 11:43 AM