Covered Entity Details

FQHCLA390 MERCY MEDICAL HEALTH CENTER (Active) - information as of 6/17/2025 11:40:03 PM

Main Details

Name

MERCY MEDICAL HEALTH CENTER

Subdivision Name

Mercy Medical Health Center

Type

Health Center Program Look-Alike

Site ID

BPS-LAL-034444

340B ID

FQHCLA390

Grant Number

LALCS31662

Additional Details

Current Program Status

Active

Registration Date

4/2/2019

Participating Start Date

7/1/2019

Participating Approval Date

6/10/2019

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Mercy Medical Health Center
Kimberly Lynn Brunson, CEO
(318) 259-1100

Primary Contact

Mercy Medical Health Center
Christi Permenter, Pharmacy Manager
(318) 475-3500 Ext: 502

Addresses

Street Address

244 Bond Street
Jonesboro, LA 71251

Billing Address

Mercy Medical Health Center
PO Box 70
Hodge, LA 71247

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
LA	2468588,2208012	1063945434,1477162972

Shipping Addresses

Shipping Address 1

Mercy Medical Health Center dba Mercy Medicine
244 Bond Street
Jonesboro, LA 71251

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/02/2024	04/01/2024		12/23/2024
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/02/2024	04/01/2024		12/23/2024
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/02/2024	04/01/2024		04/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/02/2024	04/01/2024		04/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/02/2024	04/01/2024		04/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	01/02/2024	04/01/2024		04/01/2024
Contract Detail	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	01/10/2020	04/01/2020	10/21/2022	10/21/2022
Contract Detail	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	01/10/2020	04/01/2020	10/21/2022	10/21/2022
Contract Detail	FAMILY PHARMACY JONESBORO, LLC	FAMILY PHARMACY	500 ALEXANDER ST.	JONESBORO	LA	71251	07/15/2019	10/01/2019		12/16/2024
Contract Detail	MITCHELL'S PHARMACY	DWAYNE MITCHELL	202 E MAIN ST	JONESBORO	LA	71251	07/01/2019	10/01/2019		10/01/2019
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/15/2025	04/01/2025		04/01/2025
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/15/2025	04/01/2025		04/01/2025
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	01/15/2025	04/01/2025		04/01/2025
Contract Detail	PHARMACY SERVICES/WINNFIELD/IN	STEPHEN SHELTON	100 W MAIN ST, P O BOX 1437	WINNFIELD	LA	71483	04/14/2023	07/01/2023	08/01/2024	09/19/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/10/2020	04/01/2020		04/01/2020
Contract Detail	WAL-MART PHARMACY 10-0149	184 OLD WINFIELD RD.		JONESBORO	LA	71251	01/10/2020	04/01/2020		12/23/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/10/2020	04/01/2020		04/01/2020
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/12/2023	01/01/2024		01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
FQHCLA390	Active	BPS-LAL-034444	MERCY MEDICAL HEALTH CENTER	Mercy Medical Health Center	244 Bond Street	Jonesboro	LA
FQHCLA390A	Terminated	BPS-LAL-031119	Mercy Medical Health Center	Mercy Medical Quick Care	4629 Quitman Hwy	Hodge	LA
FQHCLA390B	Active	BPS-LAL-034116	Mercy Medical Health Center	Mercy Dental	900 S Vienna St	Ruston	LA
FQHCLA390C	Active	BPS-LAL-039290	MERCY MEDICAL HEALTH CENTER	Mercy Medical Health Center of Arcadia and Mercy Medicine of Arcadia	600 Factory Outlet Dr, Ste 12	Arcadia	LA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
FQHCLA390	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2024
FQHCLA390	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2024
FQHCLA390	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2024
FQHCLA390	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2024
FQHCLA390	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2024
FQHCLA390	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2024
FQHCLA390	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	04/01/2020	10/21/2022
FQHCLA390	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	04/01/2020	10/21/2022
FQHCLA390	FAMILY PHARMACY JONESBORO, LLC	FAMILY PHARMACY	500 ALEXANDER ST.	JONESBORO	LA	71251	10/01/2019
FQHCLA390	MITCHELL'S PHARMACY	DWAYNE MITCHELL	202 E MAIN ST	JONESBORO	LA	71251	10/01/2019
FQHCLA390	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/01/2025
FQHCLA390	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/01/2025
FQHCLA390	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/01/2025
FQHCLA390	PHARMACY SERVICES/WINNFIELD/IN	STEPHEN SHELTON	100 W MAIN ST, P O BOX 1437	WINNFIELD	LA	71483	07/01/2023	08/01/2024
FQHCLA390	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2020
FQHCLA390	WAL-MART PHARMACY 10-0149	184 OLD WINFIELD RD.		JONESBORO	LA	71251	04/01/2020
FQHCLA390	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2020
FQHCLA390	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 3:18:57 PM	2/10/2025 11:21:30 AM	2/10/2025 11:21 AM
Contacts	Authorizing Official	Update	Profile Change Request	Brunson, Kimberly Lynn AO Mercy Medical Health Center 3182591100	Brunson, Kimberly Lynn CEO Mercy Medical Health Center 3182591100	9/20/2024 6:14 AM
Details	Last Recertification Date	Update	Recertification	1/30/2023 9:26:59 PM	1/30/2024 3:18:57 PM	1/30/2024 3:18 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1548879034 (LA)		5/2/2023 5:05 PM
Contacts	Primary Contact	Update	Change Request	Becks, Rennata Office Manager Mercy Medical Health Center 3182591100	Permenter, Christi Pharmacy Manager Mercy Medical Health Center 3184753500-502	3/27/2023 3:13 PM
Details	Last Recertification Date	Update	Recertification	1/31/2022 1:27:59 PM	1/30/2023 9:26:59 PM	1/30/2023 9:26 PM
Addresses	Main Address	Update	Change Request	4633 Quitman Hwy Hodge, LA 71247	244 Bond Street Jonesboro, LA 71251	6/16/2022 11:47 AM
Addresses	Billing Address	Update	Change Request	PO Box 70 4633 Quitman Hwy Hodge, LA 71247	Mercy Medical Health Center PO Box 70 Hodge, LA 71247	6/16/2022 11:47 AM
Addresses	Shipping Address	Update	Change Request	Mercy Medical Health Center dba Mercy Medicine 4631 Quitman Hwy Hodge, LA 71247	Mercy Medical Health Center dba Mercy Medicine 244 Bond Street Jonesboro, LA 71251	6/16/2022 11:47 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 2:59:26 PM	1/31/2022 1:27:59 PM	1/31/2022 1:27 PM
Details	Last Recertification Date	Update	Recertification	1/29/2020 1:02:05 AM	2/4/2021 2:59:26 PM	2/4/2021 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/11/2020 2:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2208012	11/11/2020 2:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	11/11/2020 2:43 PM
Contacts	Authorizing Official	Update	AO Change Request	Brunson, Kim CEO Mercy Medical Health Center 3182591100	Brunson, Kimberly Lynn AO Mercy Medical Health Center 3182591100	10/19/2020 6:49 AM
Addresses	Shipping Address	Delete	Change Request	Mercy Medical Health Center 4631 Quitman Hwy Hodge, LA 71247		9/21/2020 7:04 AM
Addresses	Shipping Address	Insert	Change Request		Mercy Medical Health Center dba Mercy Medicine 4631 Quitman Hwy Hodge, LA 71247	9/21/2020 7:04 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/21/2020 7:04 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2468588	9/21/2020 7:04 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	9/21/2020 7:04 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1063945434	9/21/2020 7:04 AM
Medicaid Billing	NPI: State	Insert	Change Request		LA	9/21/2020 7:04 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1477162972	9/21/2020 7:04 AM
Medicaid Billing	NPI: State	Insert	Change Request		LA	9/21/2020 7:04 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1548879034	9/21/2020 7:04 AM
Medicaid Billing	NPI: State	Insert	Change Request		LA	9/21/2020 7:04 AM
Addresses	Shipping Address	Insert	Change Request		Mercy Medical Health Center 4631 Quitman Hwy Hodge, LA 71247	9/10/2020 10:30 AM
Details	Last Recertification Date	Update	Recertification		1/29/2020 1:02:05 AM	1/29/2020 1:02 AM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Brunson, Kim CEO Mercy Medical Health Center 3182591100	6/10/2019 8:09 AM
Details	340B ID	Update	New Registration		FQHCLA390	6/10/2019 8:09 AM
Dates	Participating Approval Date	Update	New Registration		6/10/2019 8:09:29 AM	6/10/2019 8:09 AM
Details	State	Update	New Registration	Pending	Approved	6/10/2019 8:09 AM
Dates	Signed By Date	Update	New Registration		4/2/2019 2:31:32 PM	6/10/2019 8:09 AM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	6/10/2019 8:09 AM
Addresses	Main Address	Insert	New Registration		4633 Quitman Hwy Hodge, LA 71247	4/2/2019 2:31 PM
Addresses	Billing Address	Insert	New Registration		PO Box 70 4633 Quitman Hwy Hodge, LA 71247	4/2/2019 2:31 PM
Contacts	Authorizing Official	Insert	New Registration		Brunson, Kim CEO Mercy Medical Health Center 3182591100	4/2/2019 2:31 PM
Contacts	Primary Contact	Insert	New Registration		Becks, Rennata Office Manager Mercy Medical Health Center 3182591100	4/2/2019 2:31 PM
Details	Last Recertification Date	Insert	New Registration			4/2/2019 2:31 PM
Details	Grant Number	Insert	New Registration		LALCS31662	4/2/2019 2:31 PM
Details	340B ID	Insert	New Registration			4/2/2019 2:31 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2019 2:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2019 2:31 PM
Details	Medicare Provider Number	Insert	New Registration			4/2/2019 2:31 PM
Details	Entity Name	Insert	New Registration		MERCY MEDICAL HEALTH CENTER	4/2/2019 2:31 PM
Details	Program Code	Insert	New Registration		FQHCLA	4/2/2019 2:31 PM
Details	Entity Subname	Insert	New Registration		Mercy Medical Health Center	4/2/2019 2:31 PM
Dates	Participating Approval Date	Insert	New Registration			4/2/2019 2:31 PM
Details	State	Insert	New Registration		Pending	4/2/2019 2:31 PM
Dates	Registration Date	Insert	New Registration		4/2/2019 2:31:30 PM	4/2/2019 2:31 PM
Dates	Signed By Date	Insert	New Registration			4/2/2019 2:31 PM
Dates	Start Date	Insert	New Registration			4/2/2019 2:31 PM
Terminations	Termination Comments	Insert	New Registration			4/2/2019 2:31 PM
Terminations	Termination Date	Insert	New Registration			4/2/2019 2:31 PM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2019 2:31 PM
Terminations	Termination Reason	Insert	New Registration			4/2/2019 2:31 PM

340B Drug Pricing Program Database