Covered Entity Details

CAH251325-08 COVINGTON COUNTY HOSPITAL (Active) - information as of 5/9/2025 10:44:52 PM

Main Details

Name

COVINGTON COUNTY HOSPITAL

Subdivision Name

CCH Clinic Taylorsville

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH251325-08

Medicare Provider Number

251325

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/15/2021

Participating Start Date

10/1/2021

Participating Approval Date

7/21/2021

Last Recertification Date

8/27/2024

Contacts

Authorizing Official

Covington County Hospital
Gregg Gibbes, CEO
(601) 765-6711

Primary Contact

Covington County Hospital
Delilah Hudson, Controller
(601) 765-6711 Ext: 126

Addresses

Street Address

105 EATON ST
EXPRESS CARE TAYLORSVILLE
TAYLORSVILLE, MS 39168-5614

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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
MS	02423709	1306460282

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH251325-01	Child	CAH	COVINGTON COUNTY HOSPITAL	Green Tree Family Medical Clinic	603 S Main St	Mt Olive	MS	Active
CAH251325-02	Child	CAH	COVINGTON COUNTY HOSPITAL	Family Care Seminary	104 West Main Suite 20	Seminary	MS	Active
CAH251325-03	Child	CAH	COVINGTON COUNTY HOSPITAL	Family Care Main Street	210 Main Street	Collins	MS	Terminated
CAH251325-04	Child	CAH	COVINGTON COUNTY HOSPITAL	Family Care Express	3275 Hwy 49 North, Suite E	Collins	MS	Active
CAH251325-05	Child	CAH	COVINGTON COUNTY HOSPITAL	CCH Clinic Family Medical	301 Hospital Blvd.	Collins	MS	Active
CAH251325-06	Child	CAH	COVINGTON COUNTY HOSPITAL	COVINGTON COUNTY HOSPITAL - Medical Center of Magee	800 3RD ST SW	MAGEE	MS	Active
CAH251325-07	Child	CAH	COVINGTON COUNTY HOSPITAL	COVINGTON COUNTY HOSPITAL - Rural Health Clinic	1039 HIGHWAY 42 STE 3	SUMRALL	MS	Active
CAH251325-08	Child	CAH	COVINGTON COUNTY HOSPITAL	CCH Clinic Taylorsville	105 EATON ST	TAYLORSVILLE	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/16/2025 1:58 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		02423709	1/16/2025 1:58 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	1/16/2025 1:58 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1306460282	1/16/2025 1:58 PM
Medicaid Billing	NPI: State	Insert	Change Request		MS	1/16/2025 1:58 PM
Details	Last Recertification Date	Update	Recertification	8/23/2023 1:47:38 PM	8/27/2024 10:17:01 AM	8/27/2024 10:17 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 11:58:19 AM	8/23/2023 1:47:38 PM	8/23/2023 1:47 PM
Details	Entity Subname	Update	Recertification	COVINGTON COUNTY HOSPITAL - Rural Health clinic	CCH Clinic Taylorsville	8/23/2023 1:47 PM
Details	Last Recertification Date	Update	Recertification		8/29/2022 11:58:19 AM	8/29/2022 11:58 AM
Details	State	Update		Approved	Active	10/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Gibbes, Gregg CEO Covington County Hospital 6017656711	7/21/2021 12:55 PM
Details	340B ID	Update	New Registration		CAH251325-08	7/21/2021 12:55 PM
Details	Entity Subname	Update	New Registration	COVINGTON COUNTY HOSPITAL	COVINGTON COUNTY HOSPITAL - Rural Health clinic	7/21/2021 12:55 PM
Dates	Participating Approval Date	Update	New Registration		7/21/2021 12:55:44 PM	7/21/2021 12:55 PM
Details	State	Update	New Registration	Pending	Approved	7/21/2021 12:55 PM
Dates	Signed By Date	Update	New Registration		7/15/2021 6:07:25 PM	7/21/2021 12:55 PM
Dates	Start Date	Update	New Registration		10/1/2021 12:00:00 AM	7/21/2021 12:55 PM
Addresses	Main Address	Insert	New Registration		105 EATON ST EXPRESS CARE TAYLORSVILLE TAYLORSVILLE, MS 39168-5614	7/15/2021 6:07 PM
Contacts	Authorizing Official	Insert	New Registration		Gibbes, Gregg CEO Covington County Hospital 6017656711	7/15/2021 6:07 PM
Contacts	Primary Contact	Insert	New Registration		Hudson, Delilah Controller Covington County Hospital 6017656711-126	7/15/2021 6:07 PM
Details	Assistance Received From Date	Insert	New Registration			7/15/2021 6:07 PM
Details	Assistance Received To Date	Insert	New Registration			7/15/2021 6:07 PM
Details	Last Recertification Date	Insert	New Registration			7/15/2021 6:07 PM
Details	Grant Number	Insert	New Registration			7/15/2021 6:07 PM
Details	340B ID	Insert	New Registration			7/15/2021 6:07 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/15/2021 6:07 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/15/2021 6:07 PM
Details	Medicare Provider Number	Insert	New Registration		251325	7/15/2021 6:07 PM
Details	Entity Name	Insert	New Registration		COVINGTON COUNTY HOSPITAL	7/15/2021 6:07 PM
Details	NOFO Number	Insert	New Registration			7/15/2021 6:07 PM
Details	Program Code	Insert	New Registration		CAH	7/15/2021 6:07 PM
Details	Entity Subname	Insert	New Registration		COVINGTON COUNTY HOSPITAL	7/15/2021 6:07 PM
Dates	Participating Approval Date	Insert	New Registration			7/15/2021 6:07 PM
Details	State	Insert	New Registration		Pending	7/15/2021 6:07 PM
Dates	Registration Date	Insert	New Registration		7/15/2021 6:07:21 PM	7/15/2021 6:07 PM
Dates	Signed By Date	Insert	New Registration			7/15/2021 6:07 PM
Dates	Start Date	Insert	New Registration			7/15/2021 6:07 PM
Terminations	Termination Comments	Insert	New Registration			7/15/2021 6:07 PM
Terminations	Termination Date	Insert	New Registration			7/15/2021 6:07 PM
Terminations	Termination Effective Date	Insert	New Registration			7/15/2021 6:07 PM
Terminations	Termination Reason	Insert	New Registration			7/15/2021 6:07 PM