Covered Entity Details

CH04518W Community Health Care Systems Inc (Active) - information as of 5/2/2025 10:41:09 PM

Main Details

Name

Community Health Care Systems Inc

Subdivision Name

CHCS, INC – Mobile Unit

Type

HRSA-Funded Health Center

Site ID

BPS-H80-031051

340B ID

CH04518W

Grant Number

H80CS00507

Additional Details

Current Program Status

Active

Registration Date

8/19/2020

Participating Start Date

10/1/2020

Participating Approval Date

8/24/2020

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Community Health Care Systems, Inc.
Carla Belcher, CEO
(478) 552-7384 Ext: 1211

Primary Contact

Community Health Care Systems, Inc
Jason Lee Powell, Chief Financial Officer
(478) 552-7384 Ext: 1226

Addresses

Street Address

4292 Gray Hwy
Gray, GA 31032-5900

Billing Address

COMMUNITY HEALTH CARE SYSTEMS, INC
2251 WEST ELM STREET
P.O. BOX 371
WRIGHTSVILLE, GA 31096

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	003144757A	1932150422

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	City	State
CH045180	Active	BPS-H80-004922	COMMUNITY HEALTH CARE SYSTEMS INC	COMMUNITY HEALTH CARE SYSTEMS, INC.	2251 W Elm St	Wrightsville	GA
CH04518A	Active	BPS-H80-003515	COMMUNITY HEALTH CARE SYSTEMS INC	TENNILLE COMMUNITY HLTH CENTER	116 SMITH ST	TENNILLE	GA
CH04518B	Active	BPS-H80-000701	COMMUNITY HEALTH CARE SYSTEMS INC	SANDERSVILLE COMMUNITY HLTH CTR	616 Ferncrest Dr	Sandersville	GA
CH04518C	Active	BPS-H80-002869	COMMUNITY HEALTH CARE SYSTEMS INC	COMMUNITY HEALTH CARE SYSTEMS-WILKINSON	144 E Main St	Irwinton	GA
CH04518E	Active	BPS-H80-014278	COMMUNITY HEALTH CARE SYSTEMS INC	Community Health Care Systems Inc.-Laurens County	107 FAIRVIEW PARK DR	DUBLIN	GA
CH04518F	Active	BPS-H80-018398	COMMUNITY HEALTH CARE SYSTEMS INC	Community Health Care Systems, Inc.- Telfair County	280 E Willow Creek Ln	McRae	GA
CH04518G	Active	BPS-H80-012792	COMMUNITY HEALTH CARE SYSTEMS INC	Community Health Care Systems, Inc.	101 Watson Rd. STE B	Jeffersonville	GA
CH04518H	Active	BPS-H80-014200	COMMUNITY HEALTH CARE SYSTEMS INC	TriCounty Health System - Warrenton	1008 ATLANTA HWY	WARRENTON	GA
CH04518J	Active	BPS-H80-018043	COMMUNITY HEALTH CARE SYSTEMS INC	TriCounty Health System - Gibson	702 W Main St	GIBSON	GA
CH04518K	Active	BPS-H80-014198	COMMUNITY HEALTH CARE SYSTEMS INC	TriCounty Health System - Sparta	675 HAMILTON ST	SPARTA	GA
CH04518L	Active	BPS-H80-014280	COMMUNITY HEALTH CARE SYSTEMS INC	Community Health Care Systems Inc.- Wrens, GA	623 North Main Street	Wrens	GA
CH04518M	Active	BPS-H80-014279	COMMUNITY HEALTH CARE SYSTEMS INC	Community Health Care Systems, Inc.- Jones County	4292 GRAY HIGHWAY	GRAY	GA
CH04518N	Active	BPS-H80-014883	COMMUNITY HEALTH CARE SYSTEMS INC	Community Health Care Systems, Inc. Baldwin County	102A AIRPORT RD NE	MILLEDGEVILLE	GA
CH04518P	Terminated	BPS-H80-018399	COMMUNITY HEALTH CARE SYSTEMS INC	Community Health Care Systems Inc - Dental	2562 East Elm Street	Wirghtsville	GA
CH04518Q	Active	BPS-H80-018194	COMMUNITY HEALTH CARE SYSTEMS INC	Community Health Care Systems, Inc. Johnson County Schools	2160 W Elm Street	Wrightsville	GA
CH04518R	Active	BPS-H80-018045	COMMUNITY HEALTH CARE SYSTEMS INC	East Georgia Healthcare Center - Wadley	257 N Main St	Wadley	GA
CH04518S	Active	BPS-H80-027532	Community Health Care Systems Inc	Community Health Care Systems-Bibb	250 Martin Luther King Jr Blvd STE 200	Macon	GA
CH04518T	Active	BPS-H80-027161	Community Health Care Systems Inc	Community Health Care Systems, Inc. - Taliaferro	557A Broad St NW	Crawfordville	GA
CH04518U	Active	BPS-H80-030355	Community Health Care Systems Inc	Community Health Care Systems Inc-WILKINSON	218 Milledgeville Highway	Gordon	GA
CH04518V	Active	BPS-H80-031158	Community Health Care Systems Inc	CHCS,INC - Mobile Unit Two	1008 Atlanta Hwy	Warrenton	GA
CH04518W	Active	BPS-H80-031051	Community Health Care Systems Inc	CHCS, INC – Mobile Unit	4292 Gray Hwy	Gray	GA
CH04518X	Active	BPS-H80-031110	Community Health Care Systems Inc	CHCS, INC-BALDWIN SCHOOL	100 North ABC St	MILLEDGEVILLE	GA
CH04518Y	Active	BPS-H80-035823	COMMUNITY HEALTH CARE SYSTEMS, INC.	Community Health Care Systems, Inc - Hancock School	10571 Ga Highway 15	Sparta	GA
CH04518Z	Active	BPS-H80-038040	COMMUNITY HEALTH CARE SYSTEMS, INC.	Community Health Care Systems, Inc. - Twiggs County Public Schools Wellness Center	675 Bullard Rd	Jeffersonville	GA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH045180	ADVANCED MEDICAL GROUP, LLC	DBA WRENS DRUG	206 E BROAD ST	WRENS	GA	30833-1109	06/06/2023
CH045180	APAA LLC	D/B/A HOLIDAY PHARMACY	6815 N. DALE MABRY HIGHWAY	TAMPA	FL	33614	01/01/2014
CH04518A	APAA LLC	D/B/A HOLIDAY PHARMACY	6815 N. DALE MABRY HIGHWAY	TAMPA	FL	33614	01/01/2014
CH04518B	APAA LLC	D/B/A HOLIDAY PHARMACY	6815 N. DALE MABRY HIGHWAY	TAMPA	FL	33614	01/01/2014
CH04518C	APAA LLC	D/B/A HOLIDAY PHARMACY	6815 N. DALE MABRY HIGHWAY	TAMPA	FL	33614	01/01/2014
CH04518E	APAA LLC	D/B/A HOLIDAY PHARMACY	6815 N. DALE MABRY HIGHWAY	TAMPA	FL	33614	01/01/2014
CH045180	COLISEUM PARK PROFESSIONAL	380 HOSPITAL DR STE 175A		MACON	GA	31217	06/06/2023
CH045180	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	01/01/2016
CH04518H	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518A	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518B	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518C	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518E	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518F	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518G	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518J	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518K	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518L	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518M	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518N	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518Q	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518R	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518S	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH04518T	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	10/01/2019
CH045180	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	01/01/2016
CH04518H	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518A	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518B	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518C	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518E	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518F	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518G	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518J	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518K	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518L	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518M	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518N	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518Q	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518R	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518S	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH04518T	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/01/2019
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05353	1025 HILLCREST PKWY.	DUBLIN	GA	31021	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04251	423 S. WAYNE ST	MILLEDGEVILLE	GA	31061	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04589	869 HORIZON SOUTH PARKWAY	GROVETOWN	GA	30813	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01374	800 HWY 96	WARNER ROBINS	GA	31088	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16468	235 ROBERT C DANIEL JR PKWY	AUGUSTA	GA	30909	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01586	3001 RICHARD B. RUSSELL PARKWAY	WARNER ROBINS	GA	31088	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04593	206 S. HARRIS ST.	SANDERSVILLE	GA	31082	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07706	430 TIFT COLLEGE DR.	FORSYTH	GA	31029	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04209	3231 WRIGHTSBORO ROAD	AUGUSTA	GA	30909	04/01/2020	09/15/2022
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10357	1544 BASS RD.	MACON	GA	31210	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04518	920 E. ROBERT TOOMBS AVE.	WASHINGTON	GA	30673	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04160	6381 ZEBULON RD.	MACON	GA	31220	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04545	1615 FOREST HILL RD.	MACON	GA	31210	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04119	2902 PEACH ORCHARD ROAD	AUGUSTA	GA	30906	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04580	330 EAST GREEN STREET	MONTICELLO	GA	31064	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04564	535 OAK ST.	EASTMAN	GA	31023	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04591	1633 GORDON HWY	AUGUSTA	GA	30906	04/01/2020	04/30/2022
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07200	202 N.E. DYKES ST.	COCHRAN	GA	31014	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04583	2703 WASHINGTON RD.	AUGUSTA	GA	30909	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07746	2559 WINDSOR SPRING ROAD	AUGUSTA	GA	30906	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04765	4080 BLOOMFIELD RD.	MACON	GA	31206	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04565	960 N COLUMBIA ST	MILLEDGEVILLE	GA	31061	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07504	4585 HARTLEY BRIDGE RD.	MACON	GA	31216	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04556	109 WEST HILL STREET	THOMSON	GA	30824	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07212	1271 GRAY HIGHWAY	MACON	GA	31211	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02472	1390 PIO NONO AVENUE	MACON	GA	31204	04/01/2020	04/30/2022
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03378	1520 WALTON WAY	AUGUSTA	GA	30904	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04571	92 S. TALLAHASSEE ST.	HAZLEHURST	GA	31539	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04255	3012 HARTLEY BRIDGE RD.	MACON	GA	31216	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07744	809 OAK ST	EATONTON	GA	31024	04/01/2020
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03772	4291 MERCER UNIVERSITY DRIVE	MACON	GA	31204	04/01/2020	06/02/2022
CH045180	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05631	805 RUSSELL PKWY.	WARNER ROBINS	GA	31088	04/01/2020
CH04518A	KROGER DRUGSTORE #328	660 NORTH AVE		MACON	GA	31211-1494	10/01/2020
CH045180	KROGER DRUGSTORE #328	660 NORTH AVE		MACON	GA	31211-1494	10/01/2020	05/15/2023
CH04518A	KROGER DRUGSTORE #355	4650 FORSYTH RD		MACON	GA	31210	10/01/2020	08/05/2020
CH04518A	KROGER DRUGSTORE #378	220 TOM HILL SR BLVD		MACON	GA	31210	10/01/2020
CH045180	KROGER DRUGSTORE #378	220 TOM HILL SR BLVD		MACON	GA	31210	10/01/2020	05/15/2023
CH04518A	KROGER DRUGSTORE #400	4321 HARTLEY BRIDGE RD		MACON	GA	31216-5641	10/01/2020
CH045180	KROGER DRUGSTORE #400	4321 HARTLEY BRIDGE RD		MACON	GA	31216-5641	10/01/2020	05/15/2023
CH04518A	KROGER DRUGSTORE #411	4628 PRESIDENTIAL PKWY		MACON	GA	31206	10/01/2020	08/05/2020
CH04518A	KROGER DRUGSTORE #425	5928 ZEBULON ROAD		MACON	GA	31210	10/01/2020
CH045180	KROGER DRUGSTORE #425	5928 ZEBULON ROAD		MACON	GA	31210	10/01/2020	05/15/2023
CH04518A	KROGER DRUGSTORE #674	1100 HILLCREST PKWY.		DUBLIN	GA	31021	10/01/2020
CH045180	KROGER DRUGSTORE #674	1100 HILLCREST PKWY.		DUBLIN	GA	31021	10/01/2020
CH04518A	KROGER PHARMACY #694	2809 N. COLUMBIA ST.		MILLEDGEVILLE	GA	31061	10/01/2020	08/05/2020
CH045180	LITTLE CREEK DRUG LLC	DBA: SMITH'S PHARMACY	141 EIGHTH ST	MC RAE HELENA	GA	31037	06/06/2023
CH045180	MCRAE DRUG COMPANY, LLC	D/B/A RYALS DRUGSTORE	12 S SECOND AVE	MC RAE HELENA	GA	31055	01/13/2025
CH045180	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	10/01/2024
CH045180	POWELLS BLOOMFIELD PHCY INC-CORP	4839 BLOOMFIELD RD.		MACON	GA	31206	06/06/2023
CH045180	RYALS DRUG STORE	12 S SECOND AVE		MC RAE	GA	31055-4659	10/01/2023	09/16/2024
CH045180	SANDERSVILLE DRUG CO.	528 SPARTA RD		SANDERSVILLE	GA	31082-1859	06/06/2023
CH045180	SWAN PHARMACY, INC.	PO BOX 69	48 N MAIN ST	WADLEY	GA	30477	06/06/2023
CH045180	U SAVE IT PHARMACY - MACON 2	1425 GEORGIA AVE	STE 102	MACON	GA	31201	06/06/2023
CH045180	U SAVE IT PHARMACY INC #13	3576 PIO NONO AVENUE		MACON	GA	31206	06/06/2023
CH04518E	WAL-MART PHARMACY 10-0555	2423 HIGHWAY 80 WEST		DUBLIN	GA	31021	10/01/2019
CH045180	WAL-MART PHARMACY 10-0555	2423 HIGHWAY 80 WEST		DUBLIN	GA	31021	10/01/2019
CH04518C	WAL-MART PHARMACY 10-0555	2423 HIGHWAY 80 WEST		DUBLIN	GA	31021	10/01/2019
CH04518F	WAL-MART PHARMACY 10-0555	2423 HIGHWAY 80 WEST		DUBLIN	GA	31021	10/01/2019
CH04518G	WAL-MART PHARMACY 10-0555	2423 HIGHWAY 80 WEST		DUBLIN	GA	31021	10/01/2019
CH04518Q	WAL-MART PHARMACY 10-0555	2423 HIGHWAY 80 WEST		DUBLIN	GA	31021	10/01/2019
CH04518S	WAL-MART PHARMACY 10-1076	1401 GRAY HIGHWAY		MACON (NE)	GA	31211	10/01/2019
CH045180	WAL-MART PHARMACY 10-1076	1401 GRAY HIGHWAY		MACON (NE)	GA	31211	10/01/2019
CH04518G	WAL-MART PHARMACY 10-1076	1401 GRAY HIGHWAY		MACON (NE)	GA	31211	10/01/2019
CH04518M	WAL-MART PHARMACY 10-1076	1401 GRAY HIGHWAY		MACON (NE)	GA	31211	10/01/2019
CH04518N	WAL-MART PHARMACY 10-1121	2592 N COLUMBIA ST		MILLEDGEVILLE	GA	31061	10/01/2019
CH04518M	WAL-MART PHARMACY 10-1121	2592 N COLUMBIA ST		MILLEDGEVILLE	GA	31061	10/01/2019
CH045180	WAL-MART PHARMACY 10-1121	2592 N COLUMBIA ST		MILLEDGEVILLE	GA	31061	10/01/2019
CH04518C	WAL-MART PHARMACY 10-1121	2592 N COLUMBIA ST		MILLEDGEVILLE	GA	31061	10/01/2019
CH04518G	WAL-MART PHARMACY 10-1121	2592 N COLUMBIA ST		MILLEDGEVILLE	GA	31061	10/01/2019
CH04518K	WAL-MART PHARMACY 10-1121	2592 N COLUMBIA ST		MILLEDGEVILLE	GA	31061	10/01/2019
CH045180	WAL-MART PHARMACY 10-1143	1308 SOUTH HARRIS STREET		SANDERSVILLE	GA	31082	01/01/2016
CH04518A	WAL-MART PHARMACY 10-1143	1308 SOUTH HARRIS STREET		SANDERSVILLE	GA	31082	10/01/2019
CH04518B	WAL-MART PHARMACY 10-1143	1308 SOUTH HARRIS STREET		SANDERSVILLE	GA	31082	10/01/2019
CH04518C	WAL-MART PHARMACY 10-1143	1308 SOUTH HARRIS STREET		SANDERSVILLE	GA	31082	10/01/2019
CH04518G	WAL-MART PHARMACY 10-1143	1308 SOUTH HARRIS STREET		SANDERSVILLE	GA	31082	10/01/2019
CH04518Q	WAL-MART PHARMACY 10-1143	1308 SOUTH HARRIS STREET		SANDERSVILLE	GA	31082	10/01/2019
CH04518H	WAL-MART PHARMACY 10-1658	2205 HARRISON RD		THOMSON	GA	30824	10/01/2019
CH045180	WAL-MART PHARMACY 10-1658	2205 HARRISON RD		THOMSON	GA	30824	10/01/2019
CH04518J	WAL-MART PHARMACY 10-1658	2205 HARRISON RD		THOMSON	GA	30824	10/01/2019
CH04518K	WAL-MART PHARMACY 10-1658	2205 HARRISON RD		THOMSON	GA	30824	10/01/2019
CH04518L	WAL-MART PHARMACY 10-1658	2205 HARRISON RD		THOMSON	GA	30824	10/01/2019
CH04518T	WAL-MART PHARMACY 10-1658	2205 HARRISON RD		THOMSON	GA	30824	10/01/2019
CH04518S	WAL-MART PHARMACY 10-2890	5955 ZEBULON RD		MACON	GA	31210	10/01/2019
CH04518M	WAL-MART PHARMACY 10-2890	5955 ZEBULON RD		MACON	GA	31210	10/01/2019
CH045180	WALGREEN CO	DBA: WALGREENS #10832	2350 N COLUMBIA ST	MILLEDGEVILLE	GA	31061-2091	04/01/2013
CH045180	WALGREEN CO	DBA: WALGREENS #11708	390 S. MAIN ST	SWAINSBORO	GA	30401	04/01/2013
CH045180	WALGREEN CO	DBA: WALGREENS #11940	274 W CLINTON ST	GRAY	GA	31032	04/01/2013
CH045180	WALGREEN CO	DBA: WALGREENS #11995	668 MAIN ST	THOMSON	GA	30824	07/01/2016
CH04518H	WALGREEN CO	DBA: WALGREENS #11995	668 MAIN ST	THOMSON	GA	30824	10/01/2019
CH04518J	WALGREEN CO	DBA: WALGREENS #11995	668 MAIN ST	THOMSON	GA	30824	10/01/2019
CH04518K	WALGREEN CO	DBA: WALGREENS #11995	668 MAIN ST	THOMSON	GA	30824	10/01/2019
CH04518L	WALGREEN CO	DBA: WALGREENS #11995	668 MAIN ST	THOMSON	GA	30824	10/01/2019
CH04518M	WALGREEN CO	DBA: WALGREENS #11940	274 W CLINTON ST	GRAY	GA	31032	10/01/2019
CH04518N	WALGREEN CO	DBA: WALGREENS #10832	2350 N COLUMBIA ST	MILLEDGEVILLE	GA	31061-2091	10/01/2019
CH04518R	WALGREEN CO	DBA: WALGREENS #11708	390 S. MAIN ST	SWAINSBORO	GA	30401	10/01/2019
CH04518T	WALGREEN CO	DBA: WALGREENS #11995	668 MAIN ST	THOMSON	GA	30824	10/01/2019
CH04518S	WALGREEN CO	DBA: WALGREENS #11348	2835 WATSON BLVD	WARNER ROBINS	GA	31093	01/01/2022
CH045180	WALGREEN CO	DBA: WALGREENS #11348	2835 WATSON BLVD	WARNER ROBINS	GA	31093	01/01/2022
CH045180	WALGREEN CO.	DBA: WALGREENS # 06561	1880 WATSON BLVD	WARNER ROBINS	GA	31093-3612	04/01/2013	02/17/2025
CH045180	WALGREEN CO.	DBA: WALGREENS # 06950	1280 GRAY HWY	MACON	GA	31211-1921	04/01/2013	11/09/2023
CH045180	WALGREEN CO.	DBA: WALGREENS # 07436	4905 E IRLO BRONSON MEMORIAL HWY	ST CLOUD	FL	34771	04/01/2013	10/06/2015
CH04518S	WALGREEN CO.	DBA: WALGREENS # 06950	1280 GRAY HWY	MACON	GA	31211-1921	10/01/2019
CH04518E	WALGREEN CO.	WALGREENS #19293	620 CENTRAL DR	EAST DUBLIN	GA	31027	01/01/2020
CH04518E	WALGREEN CO.	WALGREENS #19407	2000 VETERANS BLVD	DUBLIN	GA	31021	01/01/2020
CH045180	WALGREEN CO.	WALGREENS #19293	620 CENTRAL DR	EAST DUBLIN	GA	31027	01/01/2020	11/18/2020
CH045180	WALGREEN CO.	WALGREENS #19407	2000 VETERANS BLVD	DUBLIN	GA	31021	01/01/2020
CH04518S	WALGREEN CO.	DBA: WALGREENS # 06560	3888 VINEVILLE AVE	MACON	GA	31204-1865	01/01/2022
CH045180	WALGREEN CO.	DBA: WALGREENS # 06560	3888 VINEVILLE AVE	MACON	GA	31204-1865	01/01/2022
CH045180	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/01/2024
CH045180	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	2/1/2024 9:09:00 AM	2/12/2025 8:40:20 AM	2/12/2025 8:40 AM
Details	Last Recertification Date	Update	Recertification	2/3/2023 8:36:57 AM	2/1/2024 9:09:00 AM	2/1/2024 9:09 AM
Addresses	Billing Address	Insert	Recertification		COMMUNITY HEALTH CARE SYSTEMS, INC 2251 WEST ELM STREET P.O. BOX 371 WRIGHTSVILLE, GA 31096	2/3/2023 8:36 AM
Details	Last Recertification Date	Update	Recertification	2/2/2022 4:13:55 PM	2/3/2023 8:36:57 AM	2/3/2023 8:36 AM
Details	Last Recertification Date	Update	Recertification	2/9/2021 12:08:01 PM	2/2/2022 4:13:55 PM	2/2/2022 4:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/14/2021 6:39 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003144757A	6/14/2021 6:39 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	6/14/2021 6:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1932150422	6/14/2021 6:39 PM
Medicaid Billing	NPI: State	Insert	Change Request		GA	6/14/2021 6:39 PM
Details	Last Recertification Date	Update	Recertification		2/9/2021 12:08:01 PM	2/9/2021 12:08 PM
Contacts	Primary Contact	Update	Profile Change Request	Powell, Jason Lee Assistant CFO Community Health Care Systems, Inc 4785527384-1226	Powell, Jason Lee Chief Financial Officer Community Health Care Systems, Inc 4785527384-1226	2/4/2021 8:56 AM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Contacts	Signed By	Insert	New Registration		Belcher, Carla CEO Community Health Care Systems, Inc. 4785527384-1211	8/24/2020 1:31 PM
Details	340B ID	Update	New Registration		CH04518W	8/24/2020 1:31 PM
Dates	Participating Approval Date	Update	New Registration		8/24/2020 1:31:53 PM	8/24/2020 1:31 PM
Details	State	Update	New Registration	Pending	Approved	8/24/2020 1:31 PM
Dates	Signed By Date	Update	New Registration		8/19/2020 5:10:24 PM	8/24/2020 1:31 PM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	8/24/2020 1:31 PM
Addresses	Main Address	Insert	New Registration		4292 Gray Hwy Gray, GA 31032-5900	8/19/2020 5:10 PM
Contacts	Primary Contact	Insert	New Registration		Powell, Jason Lee Assistant CFO Community Health Care Systems, Inc 4785527384-1226	8/19/2020 5:10 PM
Contacts	Authorizing Official	Insert	New Registration		Belcher, Carla CEO Community Health Care Systems, Inc. 4785527384-1211	8/19/2020 5:10 PM
Details	Assistance Received From Date	Insert	New Registration			8/19/2020 5:10 PM
Details	Assistance Received To Date	Insert	New Registration			8/19/2020 5:10 PM
Details	Last Recertification Date	Insert	New Registration			8/19/2020 5:10 PM
Details	Grant Number	Insert	New Registration		H80CS00507	8/19/2020 5:10 PM
Details	340B ID	Insert	New Registration			8/19/2020 5:10 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			8/19/2020 5:10 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			8/19/2020 5:10 PM
Details	Medicare Provider Number	Insert	New Registration			8/19/2020 5:10 PM
Details	Entity Name	Insert	New Registration		Community Health Care Systems Inc	8/19/2020 5:10 PM
Details	NOFO Number	Insert	New Registration			8/19/2020 5:10 PM
Details	Program Code	Insert	New Registration		CH	8/19/2020 5:10 PM
Details	Entity Subname	Insert	New Registration		CHCS, INC – Mobile Unit	8/19/2020 5:10 PM
Dates	Participating Approval Date	Insert	New Registration			8/19/2020 5:10 PM
Details	State	Insert	New Registration		Pending	8/19/2020 5:10 PM
Dates	Registration Date	Insert	New Registration		8/19/2020 5:10:21 PM	8/19/2020 5:10 PM
Dates	Signed By Date	Insert	New Registration			8/19/2020 5:10 PM
Dates	Start Date	Insert	New Registration			8/19/2020 5:10 PM
Terminations	Termination Comments	Insert	New Registration			8/19/2020 5:10 PM
Terminations	Termination Date	Insert	New Registration			8/19/2020 5:10 PM
Terminations	Termination Effective Date	Insert	New Registration			8/19/2020 5:10 PM
Terminations	Termination Reason	Insert	New Registration			8/19/2020 5:10 PM

340B Drug Pricing Program Database