340B Drug Pricing Program Database


CH04743F GEORGIA HIGHLANDS MEDICAL SERVICE INC (Active) - information as of 6/28/2025 12:26:32 AM

Main Details
GEORGIA HIGHLANDS MEDICAL SERVICE INC
GHMS Canton Center
HRSA-Funded Health Center
BPS-H80-031232
CH04743F
H80CS00470


Additional Details
Active
10/5/2020
1/1/2021
10/6/2020
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

210 Oakside Ln
Canton, GA 30114-6417

Georgia Highlands Medical Services, inc.
475 Tribble Gap Rd
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,000192574E,003146289A,003183795A,003188430A,003168146A,003245090A,003290096A1174529192,1063419422,1407281058,1407306418,1124565650,1053702191,1811501455,1194987412,1427762707
Shipping Addresses

Same as Street Address
Contract Pharmacies
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 N STE 1400
ST PETERSBURGFL3371604/01/2014 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 10:51 AM
Medicaid BillingMedicaid: NumberInsertRecertification 003290096A2/12/2025 10:51 AM
Medicaid BillingMedicaid: StateInsertRecertification GA2/12/2025 10:51 AM
DetailsLast Recertification DateUpdateRecertification1/31/2024 4:35:42 PM2/12/2025 10:51:21 AM2/12/2025 10:51 AM
Medicaid BillingNPI: NumberInsertRecertification 11949874121/31/2024 4:35 PM
Medicaid BillingNPI: StateInsertRecertification GA1/31/2024 4:35 PM
Medicaid BillingNPI: NumberInsertRecertification 14277627071/31/2024 4:35 PM
Medicaid BillingNPI: StateInsertRecertification GA1/31/2024 4:35 PM
DetailsLast Recertification DateUpdateRecertification1/31/2023 9:49:25 AM1/31/2024 4:35:42 PM1/31/2024 4:35 PM
DetailsLast Recertification DateUpdateRecertification2/2/2022 10:22:23 AM1/31/2023 9:49:25 AM1/31/2023 9:49 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/2/2022 10:22 AM
Medicaid BillingMedicaid: NumberInsertRecertification 003245090A2/2/2022 10:22 AM
Medicaid BillingMedicaid: StateInsertRecertification GA2/2/2022 10:22 AM
Medicaid BillingNPI: NumberInsertRecertification 18115014552/2/2022 10:22 AM
Medicaid BillingNPI: StateInsertRecertification GA2/2/2022 10:22 AM
DetailsLast Recertification DateUpdateRecertification2/1/2021 4:11:38 PM2/2/2022 10:22:23 AM2/2/2022 10:22 AM
DetailsLast Recertification DateUpdateRecertification 2/1/2021 4:11:38 PM2/1/2021 4:11 PM
DetailsStateUpdate ApprovedActive1/1/2021 12:01 AM
ContactsPrimary ContactUpdateChange RequestMistry, Cheryl Pharmacy Director Georgia Highlands Medical Services,inc. 4702971013Pulliam, Jessica Pharmacist Georgia Highlands Medical Services, Inc 770887167012/7/2020 12:11 PM
ContactsSigned ByInsertNew Registration Shifflet, Todd CEO Georgia Highlands Medical Services 7708871668-110210/6/2020 9:23 AM
Details340B IDUpdateNew Registration CH04743F10/6/2020 9:23 AM
DatesParticipating Approval DateUpdateNew Registration 10/6/2020 9:23:19 AM10/6/2020 9:23 AM
DetailsStateUpdateNew RegistrationPendingApproved10/6/2020 9:23 AM
DatesSigned By DateUpdateNew Registration 10/5/2020 4:54:40 PM10/6/2020 9:23 AM
DatesStart DateUpdateNew Registration 1/1/2021 12:00:00 AM10/6/2020 9:23 AM
AddressesMain AddressInsertNew Registration  210 Oakside Ln Canton, GA 30114-641710/5/2020 1:28 PM
AddressesBilling AddressInsertNew Registration Georgia Highlands Medical Services, inc. 475 Tribble Gap Rd Cumming, GA 3004010/5/2020 1:28 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/5/2020 1:28 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 000192574C10/5/2020 1:28 PM
Medicaid BillingMedicaid: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/5/2020 1:28 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 000192574E10/5/2020 1:28 PM
Medicaid BillingMedicaid: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/5/2020 1:28 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 003146289A10/5/2020 1:28 PM
Medicaid BillingMedicaid: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/5/2020 1:28 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 003183795A10/5/2020 1:28 PM
Medicaid BillingMedicaid: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/5/2020 1:28 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 003188430A10/5/2020 1:28 PM
Medicaid BillingMedicaid: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/5/2020 1:28 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 003168146A10/5/2020 1:28 PM
Medicaid BillingMedicaid: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingNPI: NumberInsertNew Registration 117452919210/5/2020 1:28 PM
Medicaid BillingNPI: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingNPI: NumberInsertNew Registration 106341942210/5/2020 1:28 PM
Medicaid BillingNPI: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingNPI: NumberInsertNew Registration 140728105810/5/2020 1:28 PM
Medicaid BillingNPI: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingNPI: NumberInsertNew Registration 140730641810/5/2020 1:28 PM
Medicaid BillingNPI: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingNPI: NumberInsertNew Registration 112456565010/5/2020 1:28 PM
Medicaid BillingNPI: StateInsertNew Registration GA10/5/2020 1:28 PM
Medicaid BillingNPI: NumberInsertNew Registration 105370219110/5/2020 1:28 PM
Medicaid BillingNPI: StateInsertNew Registration GA10/5/2020 1:28 PM
ContactsAuthorizing OfficialInsertNew Registration Shifflet, Todd CEO Georgia Highlands Medical Services 7708871668-110210/5/2020 1:28 PM
ContactsPrimary ContactInsertNew Registration Mistry, Cheryl Pharmacy Director Georgia Highlands Medical Services,inc. 470297101310/5/2020 1:28 PM
DetailsAssistance Received From DateInsertNew Registration  10/5/2020 1:28 PM
DetailsAssistance Received To DateInsertNew Registration  10/5/2020 1:28 PM
DetailsLast Recertification DateInsertNew Registration  10/5/2020 1:28 PM
DetailsGrant NumberInsertNew Registration H80CS0047010/5/2020 1:28 PM
Details340B IDInsertNew Registration  10/5/2020 1:28 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/5/2020 1:28 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/5/2020 1:28 PM
DetailsMedicare Provider NumberInsertNew Registration  10/5/2020 1:28 PM
DetailsEntity NameInsertNew Registration GEORGIA HIGHLANDS MEDICAL SERVICE INC10/5/2020 1:28 PM
DetailsNOFO NumberInsertNew Registration  10/5/2020 1:28 PM
DetailsProgram CodeInsertNew Registration CH10/5/2020 1:28 PM
DetailsEntity SubnameInsertNew Registration GHMS Canton Center10/5/2020 1:28 PM
DatesParticipating Approval DateInsertNew Registration  10/5/2020 1:28 PM
DetailsStateInsertNew Registration Pending10/5/2020 1:28 PM
DatesRegistration DateInsertNew Registration 10/5/2020 1:28:53 PM10/5/2020 1:28 PM
DatesSigned By DateInsertNew Registration  10/5/2020 1:28 PM
DatesStart DateInsertNew Registration  10/5/2020 1:28 PM
TerminationsTermination CommentsInsertNew Registration  10/5/2020 1:28 PM
TerminationsTermination DateInsertNew Registration  10/5/2020 1:28 PM
TerminationsTermination Effective DateInsertNew Registration  10/5/2020 1:28 PM
TerminationsTermination ReasonInsertNew Registration  10/5/2020 1:28 PM