Covered Entity Details

CH044369E Primary Care Of Southwest Georgia, Inc. (Active) - information as of 6/9/2025 11:04:45 PM

Main Details

Name

Primary Care Of Southwest Georgia, Inc.

Subdivision Name

Primary Care of Southwest Georgia - Quitman

Type

HRSA-Funded Health Center

Site ID

BPS-H80-018970

340B ID

CH044369E

Grant Number

H80CS06454

Additional Details

Current Program Status

Active

Registration Date

4/12/2017

Participating Start Date

7/1/2017

Participating Approval Date

4/24/2017

Last Recertification Date

2/21/2025

Contacts

Authorizing Official

Primary Care of Southwest Georgia
EDWIN JAMES, CFO
(229) 723-2660 Ext: 2131

Primary Contact

Primary Care of Southwest Georgia
Melody Parker, Pharmacy Manager
(229) 516-8877

Addresses

Street Address

907 N. Court St
Quitman, GA 31643-1315

Billing Address

PRIMARY CARE OF SOUTHWEST GEORGIA, INC.
360 COLLEGE STREET
BLAKELY, GA 39823

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
GA	003189961A	1790223352,1780607754

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
Contract Detail	K & D PHARMACY, INC.	DBA: LEE AND PICKELS DRUGSTORE	121 N LEE ST	QUITMAN	GA	31643	07/11/2023	10/01/2023			10/01/2023
Contract Detail	LEE AND PICKELS DRUGS - TROUPEVILLE	19664 VALDOSTA HWY STE A		VALDOSTA	GA	31602-8300	07/11/2024	10/01/2024			10/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH044369A	Active	BPS-H80-003406	PRIMARY CARE OF SOUTHWEST GEORGIA, INC.		360 COLLEGE STREET	BLAKELY	GA
CH044369B	Active	BPS-H80-013238	PRIMARY CARE OF SOUTHWEST GEORGIA, INC.	PCSG - Thomasville	454 Smith Ave	Thomasville	GA
CH044369C	Terminated	BPS-H80-014732	PRIMARY CARE OF SOUTHWEST GEORGIA, INC.	Primary Care of Southwest Georgia Womens Center	916 S BROAD ST	THOMASVILLE	GA
CH044369D	Active	BPS-H80-015194	PRIMARY CARE OF SOUTHWEST GEORGIA, INC.	PCSG - Bainbridge	509 Wheat Ave.	Bainbridge	GA
CH044369E	Active	BPS-H80-018970	Primary Care Of Southwest Georgia, Inc.	Primary Care of Southwest Georgia - Quitman	907 N. Court St	Quitman	GA
CH044369F	Active	BPS-H80-021150	Primary Care Of Southwest Georgia, Inc.	Primary Care of Southwest Georgia . - TCMS	4681 US Hwy 84 Bypass	Thomasville	GA
CH044369G	Active	BPS-H80-032894	Primary Care Of Southwest Georgia, Inc.	Primary Care of Southwest Georgia - Early County Elementary School	283 Martin Luther King Jr Blvd	Blakely	GA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH044369A	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	10/01/2014	12/01/2019
CH044369A	BAINBRIDGE PHARMACY	1420 E EVANS ST		BAINBRIDGE	GA	39819-4336	07/01/2016
CH044369D	BAINBRIDGE PHARMACY	1420 E EVANS ST		BAINBRIDGE	GA	39819-4336	10/01/2023
CH044369A	COLQUITT PHARMACY INC	215 W MAIN ST.		COLQUITT	GA	39837	01/01/2022	12/18/2024
CH044369A	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	10/01/2017	05/31/2023
CH044369A	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2017	05/31/2023
CH044369A	FREDS PHARMACY #1461	409 W 3RD ST		DONALSONVILLE	GA	39845-1511	10/01/2018	05/02/2022
CH044369A	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05618	11685 COLUMBIA ST.,	BLAKELY	GA	39823	07/01/2017
CH044369A	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04535	817 EAST SHOTWELL ST	BAINBRIDGE	GA	39819	04/01/2020
CH044369A	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04515	14857 US HWY 19 S.	THOMASVILLE	GA	31792	04/01/2020
CH044369A	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04534	2205 N ASHLEY ST	VALDOSTA	GA	31602	04/01/2020
CH044369G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05618	11685 COLUMBIA ST.,	BLAKELY	GA	39823	07/01/2024
CH044369F	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04515	14857 US HWY 19 S.	THOMASVILLE	GA	31792	10/01/2024
CH044369A	HALL DRUG CO INC		90 COURT SQUARE PO BOX 191	BLAKELY	GA	39823	03/06/2006
CH044369G	HALL DRUG CO INC		90 COURT SQUARE PO BOX 191	BLAKELY	GA	39823	10/01/2024
CH044369A	K & D PHARMACY, INC.	DBA: LEE AND PICKELS DRUGSTORE	121 N LEE ST	QUITMAN	GA	31643	07/01/2017
CH044369E	K & D PHARMACY, INC.	DBA: LEE AND PICKELS DRUGSTORE	121 N LEE ST	QUITMAN	GA	31643	10/01/2023
CH044369A	LEE AND PICKELS DRUGS - TROUPEVILLE	19664 VALDOSTA HWY STE A		VALDOSTA	GA	31602-8300	10/01/2023
CH044369E	LEE AND PICKELS DRUGS - TROUPEVILLE	19664 VALDOSTA HWY STE A		VALDOSTA	GA	31602-8300	10/01/2024
CH044369A	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2018	07/10/2023
CH044369A	MANIFEST PHARMACY, LLC	1018 S BATESVILLE RD	STE 4A	GREER	SC	29650-5203	07/01/2013	01/01/2016
CH044369A	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	07/01/2025
CH044369A	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	07/01/2025
CH044369A	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2018	07/10/2023
CH044369A	SAMSON MERGER SUB, LLC	HARVEYS SUPERMARKET #1646	12246 COLUMBIA STREET SUITE F	BLAKELY	GA	39823-2560	07/01/2017	10/01/2021
CH044369A	SAMSON MERGER SUB, LLC	HARVEYS SUPERMARKET #1620	1404 E JACKSON STREET	THOMASVILLE	GA	31792-3937	04/01/2018	05/02/2022
CH044369A	SAMSON MERGER SUB, LLC	HARVEYS SUPERMARKET #1666	1207 W SCREVEN STREET	QUITMAN	GA	31643-1817	04/01/2018	05/02/2022
CH044369A	SOUTHERN SCRIPTS, LLC D/B/A TRUMARX DRUG	501 GORDON AVE		THOMASVILLE	GA	31792-6645	01/01/2020	04/30/2023
CH044369A	THOMAS DRUG STORE #2		816 GORDON AVENUE P.O. BOX 350	THOMASVILLE	GA	31792	04/01/2020
CH044369A	THOMAS DRUG STORE INC #200		108 S BROAD ST	THOMASVILLE	GA	31792	04/01/2020
CH044369A	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2020
CH044369A	WAL-MART PHARMACY 10-0889	15328 US 19 SOUTH		THOMASVILLE	GA	31757	04/01/2020
CH044369F	WAL-MART PHARMACY 10-0889	15328 US 19 SOUTH		THOMASVILLE	GA	31757	07/01/2024
CH044369A	WAL-MART PHARMACY 10-0899	340 NORMAN DR		VALDOSTA	GA	31601	04/01/2020
CH044369A	WAL-MART PHARMACY 10-5422	500 EAST ALICE STREET		BAINBRIDGE	GA	39819	04/01/2020
CH044369D	WAL-MART PHARMACY 10-5422	500 EAST ALICE STREET		BAINBRIDGE	GA	39819	10/01/2024
CH044369A	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2020
CH044369A	WALGREEN CO	DBA: WALGREENS #10831	1410 E SHOTWELL ST	BAINBRIDGE	GA	39819	04/01/2016
CH044369A	WALGREEN CO	DBA: WALGREENS #11107	501 US HIGHWAY 84 E	CAIRO	GA	39828	04/01/2016
CH044369A	WALGREEN CO	DBA: WALGREENS #11794	11343 US HIGHWAY 319 N	THOMASVILLE	GA	31757	04/01/2016
CH044369B	WALGREEN CO	DBA: WALGREENS #11794	11343 US HIGHWAY 319 N	THOMASVILLE	GA	31757	10/01/2014
CH044369B	WALGREEN CO	DBA: WALGREENS #10831	1410 E SHOTWELL ST	BAINBRIDGE	GA	39819	10/01/2014
CH044369B	WALGREEN CO	DBA: WALGREENS #11107	501 US HIGHWAY 84 E	CAIRO	GA	39828	10/01/2014
CH044369A	WALGREEN CO.	DBA: WALGREENS # 09305	1800 BAYTREE RD	VALDOSTA	GA	31602	07/01/2017
CH044369A	WALGREEN CO.	DBA: WALGREENS # 06899	2815 N ASHLEY STREET	VALDOSTA	GA	31602-1806	07/01/2017
CH044369A	WALGREEN CO.	RITE AID #01671	1103 WEST SCREVEN STREET	QUITMAN	GA	31643	10/01/2018	04/12/2019
CH044369A	WALGREEN CO.	WALGREENS #19880	301 S BROAD ST	THOMASVILLE	GA	31792	10/01/2018
CH044369A	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH044369A	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Recertification	PRIMARY CARE OF SOUTHWEST GEORGIA, INC. 338 COLLEGE STREET BLAKELY, GA 39823	PRIMARY CARE OF SOUTHWEST GEORGIA, INC. 360 COLLEGE STREET BLAKELY, GA 39823	2/21/2025 11:15 PM
Details	Last Recertification Date	Update	Recertification	2/21/2024 9:41:41 AM	2/21/2025 11:15:17 PM	2/21/2025 11:15 PM
Contacts	Authorizing Official	Update	Group Change Request	McVey, Angie CEO Primary Care of Southwest Georgia, Inc. 2297232660-7140	JAMES, EDWIN CFO Primary Care of Southwest Georgia 2297232660-2131	3/14/2024 4:00 PM
Contacts	Primary Contact	Update	Group Change Request	JAMES, EDWIN CFO Primary Care of Southwest Georgia 2297232660-2131	Parker, Melody Pharmacy Manager Primary Care of Southwest Georgia 2295168877	3/14/2024 4:00 PM
Contacts	Primary Contact	Update	Profile Change Request	JAMES, EDWIN CFO Primary Care of Southwest Georgia 2297232660-7131	JAMES, EDWIN CFO Primary Care of Southwest Georgia 2297232660-2131	3/14/2024 11:05 AM
Details	Last Recertification Date	Update	Recertification	2/23/2023 12:35:17 PM	2/21/2024 9:41:41 AM	2/21/2024 9:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/14/2023 1:03 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003189961A	3/14/2023 1:03 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	3/14/2023 1:03 PM
Details	Last Recertification Date	Update	Recertification	2/24/2022 9:41:24 AM	2/23/2023 12:35:17 PM	2/23/2023 12:35 PM
Details	Last Recertification Date	Update	Recertification	2/24/2021 10:13:53 AM	2/24/2022 9:41:24 AM	2/24/2022 9:41 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1790223352	2/24/2021 10:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	2/24/2021 10:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1780607754	2/24/2021 10:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	2/24/2021 10:13 AM
Details	Last Recertification Date	Update	Recertification	2/23/2020 10:06:57 AM	2/24/2021 10:13:53 AM	2/24/2021 10:13 AM
Details	Last Recertification Date	Update	Recertification	2/19/2019 9:40:14 AM	2/23/2020 10:06:57 AM	2/23/2020 10:06 AM
Contacts	Authorizing Official	Update	Profile Change Request	Toole, LaDon CEO Primary Care of Southwest Georgia, Inc. 2297232660-7140	McVey, Angie CEO Primary Care of Southwest Georgia, Inc. 2297232660-7140	1/13/2020 2:11 PM
Details	Last Recertification Date	Update	Recertification	2/13/2018 9:32:52 AM	2/19/2019 9:40:14 AM	2/19/2019 9:40 AM
Contacts	Authorizing Official	Update	Change Request	ADDISON, ANN CEO Primary Care of Southwest GA, Inc. 2297232660	Toole, LaDon CEO Primary Care of Southwest Georgia, Inc. 2297232660-7140	1/7/2019 1:57 PM
Addresses	Main Address	Update	Recertification	907 Court St Quitman, GA 31643-1315	907 N. Court St Quitman, GA 31643-1315	2/13/2018 9:32 AM
Details	Last Recertification Date	Update	Recertification		2/13/2018 9:32:52 AM	2/13/2018 9:32 AM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/13/2018 9:32 AM
Contacts	Authorizing Official	Update		ADDISON, ANN CEO 2297232660	ADDISON, ANN CEO Primary Care of Southwest GA, Inc. 2297232660	1/9/2018 3:36 PM
Contacts	Signed By	Update		ADDISON, ANN CEO 2297232660	ADDISON, ANN CEO Primary Care of Southwest GA, Inc. 2297232660	1/9/2018 3:36 PM
Contacts	Primary Contact	Update		JAMES, EDWIN CFO 2297232660	JAMES, EDWIN CFO Primary Care of Southwest Georgia 2297232660-7131	9/29/2017 9:47 AM
Contacts	Authorizing Official	Insert			ADDISON, ANN CEO 2297232660	7/5/2017 2:31 PM
Contacts	Signed By	Insert			ADDISON, ANN CEO 2297232660	7/5/2017 2:31 PM
Addresses	Main Address	Insert			907 Court St Quitman, GA 31643-1315	5/15/2017 5:53 PM
Contacts	Primary Contact	Insert			JAMES, EDWIN CFO 2297232660	5/15/2017 5:53 PM
Addresses	Billing Address	Insert			PRIMARY CARE OF SOUTHWEST GEORGIA, INC. 338 COLLEGE STREET BLAKELY, GA 39823	4/24/2017 10:27 AM
Dates	Participating Approval Date	Update			4/24/2017 12:00:00 AM	4/24/2017 10:27 AM
Details	State	Update		Pending	Active	4/24/2017 10:27 AM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	4/24/2017 10:27 AM
Details	340B ID	Update		ONLINE_REG_76706	CH044369E	4/17/2017 11:17 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_76706	4/12/2017 2:28 PM
Details	Last Recertification Date	Insert				4/12/2017 2:28 PM
Details	Grant Number	Insert			H80CS06454	4/12/2017 2:28 PM
Details	340B ID	Insert			ONLINE_REG	4/12/2017 2:28 PM
Details	Is Authorizing Official EHB Data	Insert			False	4/12/2017 2:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/12/2017 2:28 PM
Details	Medicare Provider Number	Insert				4/12/2017 2:28 PM
Details	Entity Name	Insert			Primary Care Of Southwest Georgia, Inc.	4/12/2017 2:28 PM
Details	Program Code	Insert			CH	4/12/2017 2:28 PM
Details	Entity Subname	Insert			Primary Care of Southwest Georgia - Quitman	4/12/2017 2:28 PM
Dates	Participating Approval Date	Insert				4/12/2017 2:28 PM
Details	State	Insert			Pending	4/12/2017 2:28 PM
Dates	Registration Date	Insert			4/12/2017 12:00:00 AM	4/12/2017 2:28 PM
Dates	Signed By Date	Insert			4/12/2017 12:00:00 AM	4/12/2017 2:28 PM
Dates	Start Date	Insert				4/12/2017 2:28 PM
Terminations	Termination Comments	Insert				4/12/2017 2:28 PM
Terminations	Termination Date	Insert				4/12/2017 2:28 PM
Terminations	Termination Effective Date	Insert				4/12/2017 2:28 PM
Terminations	Termination Reason	Insert				4/12/2017 2:28 PM

340B Drug Pricing Program Database