Covered Entity Details

STD30246 GWINNETT COUNTY HEALTH DEPARTMENT (Active) - information as of 5/11/2025 11:48:23 PM

Main Details

Name

GWINNETT COUNTY HEALTH DEPARTMENT

Subdivision Name

District 3-4

Type

Sexually Transmitted Diseases

340B ID

STD30246

Grant Number

NH25PS005184

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

Direct Funding (dollars received from CDC or an intermediate organization)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.

1/1/2019 - 2/28/2026

Additional Details

Current Program Status

Active

Registration Date

1/1/2001

Participating Start Date

1/1/2001

Participating Approval Date

11/23/2004

Last Recertification Date

5/7/2025

Notice of Funding Opportunity (NOFO) Number

PS19-1901

Contacts

Authorizing Official

Georgia Department of Public Health Office of STD
Latasha Terry, STD Director
(678) 644-5464

Primary Contact

GNR Public Health
Karen Heidish, Director of Pharmacy
(678) 376-3208

Addresses

Street Address

455 Grayson Hwy
LAWRENCEVILLE, GA 30046

Billing Address

Georgia Department of Public Health, Office of Pharmacy
200 Piedmont Ave SE
West Tower
1508C
Atlanta, GA 30334

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
11/30/11 addr change (was 2570 RIVERSIDE PARKWAY GA 30045); 12/4/09 UPDATED ADDR (WAS ZIP: 30245); 12/4/09 REMOVED SHIP TO (WAS GWINNETT COUNTY HEALTH DEPARTMENT, 455 GRAYSON HWY SUITE 300, LAWRENCEVILLE, 30045); 10/06/09 ADDED SHIP TO; 8/30/06 UPDATED ADDR (WAS 316 W. PIKE ST LAWRENCEVILLE GA 30246)	11/30/2011
12/4/09 UPDATED ADDR (WAS ZIP: 30245); 12/4/09 REMOVED SHIP TO (WAS GWINNETT COUNTY HEALTH DEPARTMENT, 455 GRAYSON HWY SUITE 300, LAWRENCEVILLE, 30045); 10/06/09 ADDED SHIP TO; 8/30/06 UPDATED ADDR (WAS 316 W. PIKE ST LAWRENCEVILLE GA 30246)	11/22/2010

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	000456486C,000051917B	1720175169

Shipping Addresses

Shipping Address 1

GWINNETT DISTRICT 3-4
2570 Riverside Parkway
Lawrenceville, GA 30046

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	POSITIVE IMPACT HEALTH CENTERS, INC.	PIHC PHARMACY	3350 BRECKINRIDGE BLVD STE 200A	DULUTH	GA	30096	10/15/2019	01/01/2020			01/01/2020
Contract Detail	POSITIVE IMPACT HEALTH CENTERS, INC.	PIHC PHARMACY	523 CHURCH ST STE B	DECATUR	GA	30030-2515	10/15/2019	01/01/2020			01/01/2020

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Nature of Support: Support Received To Date	Update	Recertification	1/31/2026 12:00:00 AM	2/28/2026 12:00:00 AM	5/7/2025 2:21 PM
Details	Last Recertification Date	Update	Recertification	5/7/2024 2:14:55 PM	5/7/2025 2:21:55 PM	5/7/2025 2:21 PM
Details	Last Recertification Date	Update	Recertification	5/16/2023 1:51:08 PM	5/7/2024 2:14:55 PM	5/7/2024 2:14 PM
Addresses	Main Address	Update	Change Request	455 Grayson Hwy, Suite 300 LAWRENCEVILLE, GA 30046	455 Grayson Hwy LAWRENCEVILLE, GA 30046	5/1/2024 12:09 PM
Details	Nature of Support: Support Received To Date	Update	Group Change Request	12/31/2023 12:00:00 AM	1/31/2026 12:00:00 AM	2/7/2024 12:32 PM
Addresses	Billing Address	Update	Group Change Request	Medical and Clinical Services, Office of Pharmacy 200 Piedmont Ave SE West Tower Suite 1502 Atlanta, GA 30334	Georgia Department of Public Health, Office of Pharmacy 200 Piedmont Ave SE West Tower 1508C Atlanta, GA 30334	6/15/2023 10:28 AM
Addresses	Billing Address	Update	Recertification	Georgia Department of Public Health 2 Peachtree Street Suite 9-420 Atlanta, GA 30303	Medical and Clinical Services, Office of Pharmacy 200 Piedmont Ave SE West Tower Suite 1502 Atlanta, GA 30334	5/16/2023 1:51 PM
Contacts	Primary Contact	Update	Recertification	Heidish, Karen Director of Pharmacy GNR Public Health 6783763208	Heidish, Karen Director of Pharmacy GNR Public Health 6783763208	5/16/2023 1:51 PM
Details	Last Recertification Date	Update	Recertification	5/9/2022 3:17:25 PM	5/16/2023 1:51:08 PM	5/16/2023 1:51 PM
Contacts	Authorizing Official	Update	Profile Change Request	Terry, Latasha STD Director Georgia Department of Public Health Office of STD 4046574226	Terry, Latasha STD Director Georgia Department of Public Health Office of STD 6786445464	5/14/2023 11:53 PM
Contacts	Primary Contact	Update	Profile Change Request	Schrepple, Karen Director of Pharmacy GNR Public Health 6783763208	Heidish, Karen Director of Pharmacy GNR Public Health 6783763208	5/9/2023 9:23 AM
Contacts	Primary Contact	Update	Profile Change Request	Schrepple, Karen Director of Pharmacy Gwinnett, Newton, and Rockdale Public Health 6783763208	Schrepple, Karen Director of Pharmacy GNR Public Health 6783763208	5/8/2023 12:07 PM
Details	Last Recertification Date	Update	Recertification	5/4/2021 2:37:33 PM	5/9/2022 3:17:25 PM	5/9/2022 3:17 PM
Details	Nature of Support: Support Received From Date	Update	Recertification		1/1/2019 12:00:00 AM	5/4/2021 2:37 PM
Details	Nature of Support: Support Received To Date	Update	Recertification		12/31/2023 12:00:00 AM	5/4/2021 2:37 PM
Medicaid Billing	NPI: State	Update	Recertification		GA	5/4/2021 2:37 PM
Details	Last Recertification Date	Update	Recertification	5/4/2020 10:30:50 AM	5/4/2021 2:37:33 PM	5/4/2021 2:37 PM
Details	NOFO Number	Update	Recertification		PS19-1901	5/4/2021 2:37 PM
Details	Last Recertification Date	Update	Recertification	6/2/2019 8:35:16 PM	5/4/2020 10:30:50 AM	5/4/2020 10:30 AM
Details	Grant Number	Update	Recertification	6NH25PS005184-01-01	NH25PS005184	5/4/2020 10:30 AM
Addresses	Shipping Address	Delete	Change Request	EAST METRO HEALTH DISTRICT 3-4 2570 Riverside Parkway Lawrenceville, GA 30046		12/18/2019 12:36 PM
Addresses	Shipping Address	Insert	Change Request		GWINNETT DISTRICT 3-4 2570 Riverside Parkway Lawrenceville, GA 30046	12/18/2019 12:36 PM
Addresses	Shipping Address	Delete	Change Request	Gwinnett County Health Department 2570 Riverside Parkway Lawrenceville, GA 30046		11/8/2019 9:11 AM
Addresses	Shipping Address	Insert	Change Request		EAST METRO HEALTH DISTRICT 3-4 2570 Riverside Parkway Lawrenceville, GA 30046	11/8/2019 9:11 AM
Addresses	Billing Address	Update	Change Request	Georgia Department of Public Health 2 Peachtree Street Office of Pharmacy, 9th Floor Atlanta, GA 30303	Georgia Department of Public Health 2 Peachtree Street Suite 9-420 Atlanta, GA 30303	10/18/2019 3:43 PM
Addresses	Shipping Address	Insert	Change Request		Gwinnett County Health Department 2570 Riverside Parkway Lawrenceville, GA 30046	10/2/2019 6:50 AM
Addresses	Shipping Address	Delete	Change Request	Georgia State DPH District 3-4 2570 Riverside Parkway Lawrenceville, GA 30046		10/2/2019 6:50 AM
Details	Last Recertification Date	Update	Recertification	5/15/2018 1:51:47 PM	6/2/2019 8:35:16 PM	6/2/2019 8:35 PM
Details	Grant Number	Update	Change Request	5NH25PS004329-05-00	6NH25PS005184-01-01	4/15/2019 1:56 PM
Details	Nature Of Support	Delete	Recertification	In-Kind products or services (see note below; must have been purchased with section 318 funds) ()-()		5/15/2018 1:51 PM
Details	Last Recertification Date	Update	Recertification	5/9/2017 12:00:00 AM	5/15/2018 1:51:47 PM	5/15/2018 1:51 PM
Details	Grant Number	Update	Recertification	5NH25PS004329-04-00	5NH25PS004329-05-00	5/15/2018 1:51 PM
Contacts	Authorizing Official	Update	Change Request	ALLEN, MICHELLE Maternal and Child Health Director Georgia Department of Public Health STD 4044632579	Terry, Latasha STD Director Georgia Department of Public Health Office of STD 4046574226	1/12/2018 10:27 AM
Contacts	Primary Contact	Update		Schrepple, Karen Director of Pharmacy 6783763208	Schrepple, Karen Director of Pharmacy Gwinnett, Newton, and Rockdale Public Health 6783763208	10/18/2017 7:55 AM
Contacts	Authorizing Official	Update		ALLEN, MICHELLE Maternal and Child Health Director 4044632579	ALLEN, MICHELLE Maternal and Child Health Director Georgia Department of Public Health STD 4044632579	10/12/2017 3:19 PM
Contacts	Authorizing Official	Insert			ALLEN, MICHELLE Maternal and Child Health Director 4044632579	8/1/2017 2:13 PM
Contacts	Primary Contact	Update		KITCHENS, KAREN PHARMACIST 6783763208	Schrepple, Karen Director of Pharmacy 6783763208	5/15/2017 4:10 PM
Addresses	Main Address	Insert			455 Grayson Hwy, Suite 300 LAWRENCEVILLE, GA 30046	5/9/2017 7:22 AM
Details	Last Recertification Date	Update		2/26/2016 12:00:00 AM	5/9/2017 12:00:00 AM	5/9/2017 7:21 AM
Details	Grant Number	Update		5H25PS004329-02	5NH25PS004329-04-00	5/9/2017 7:21 AM
Addresses	Billing Address	Insert			Georgia Department of Public Health 2 Peachtree Street Office of Pharmacy, 9th Floor Atlanta, GA 30303	3/3/2017 1:39 PM
Addresses	Shipping Address	Insert			Georgia State DPH District 3-4 2570 Riverside Parkway Lawrenceville, GA 30046	3/3/2017 1:39 PM
Medicaid Billing	Medicaid: Number	Update		000051917	000051917B	3/3/2017 1:39 PM
Details	Nature Of Support	Insert			Direct Funding (dollars received from CDC or an intermediate organization)	2/26/2016 9:28 AM
Medicaid Billing	NPI: Number	Insert			1720175169	2/26/2016 9:28 AM
Details	Last Recertification Date	Update		3/2/2015 12:00:00 AM	2/26/2016 12:00:00 AM	2/26/2016 9:28 AM
Details	Grant Number	Update		STD-GA	5H25PS004329-02	2/26/2016 9:28 AM
Details	Nature Of Support	Insert			In-Kind products or services (see note below; must have been purchased with section 318 funds)	3/2/2015 8:07 AM
Details	Last Recertification Date	Update		2/24/2014 12:00:00 AM	3/2/2015 12:00:00 AM	3/2/2015 8:07 AM
Contacts	Primary Contact	Insert			KITCHENS, KAREN PHARMACIST 6783763208	9/12/2014 7:15 AM
Details	Entity Subname	Update			District 3-4	9/12/2014 7:15 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/13/2014 6:47 PM
Medicaid Billing	Medicaid: Number	Insert			000456486C	8/13/2014 6:47 PM
Medicaid Billing	Medicaid: State	Insert			GA	8/13/2014 6:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/13/2014 6:47 PM
Medicaid Billing	Medicaid: Number	Insert			000051917	8/13/2014 6:47 PM
Medicaid Billing	Medicaid: State	Insert			GA	8/13/2014 6:47 PM
Details	Last Recertification Date	Update		1/1/2012 12:00:00 AM	2/24/2014 12:00:00 AM	2/24/2014 3:10 PM
Details	Last Recertification Date	Update		1/1/2011 12:00:00 AM	1/1/2012 12:00:00 AM	11/30/2011 11:23 AM
Details	Comments Public	Insert			11/30/11 addr change (was 2570 RIVERSIDE PARKWAY GA 30045); 12/4/09 UPDATED ADDR (WAS ZIP: 30245); 12/4/09 REMOVED SHIP TO (WAS GWINNETT COUNTY HEALTH DEPARTMENT, 455 GRAYSON HWY SUITE 300, LAWRENCEVILLE, 30045); 10/06/09 ADDED SHIP TO; 8/30/06 UPDATED ADDR (WAS 316 W. PIKE ST LAWRENCEVILLE GA 30246)	11/30/2011 11:23 AM
Details	Last Recertification Date	Insert			1/1/2011 12:00:00 AM	11/22/2010 6:24 PM
Details	Grant Number	Insert			STD-GA	11/22/2010 6:24 PM
Details	340B ID	Insert			STD30246	11/22/2010 6:24 PM
Details	Is Authorizing Official EHB Data	Insert				11/22/2010 6:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert				11/22/2010 6:24 PM
Details	Medicare Provider Number	Insert				11/22/2010 6:24 PM
Details	Entity Name	Insert			GWINNETT COUNTY HEALTH DEPARTMENT	11/22/2010 6:24 PM
Details	Program Code	Insert			STD	11/22/2010 6:24 PM
Details	Entity Subname	Insert				11/22/2010 6:24 PM
Dates	Participating Approval Date	Insert			11/23/2004 12:00:00 AM	11/22/2010 6:24 PM
Details	State	Insert			Active	11/22/2010 6:24 PM
Dates	Registration Date	Insert			1/1/2001 12:00:00 AM	11/22/2010 6:24 PM
Dates	Signed By Date	Insert			1/1/2011 12:00:00 AM	11/22/2010 6:24 PM
Dates	Start Date	Insert			1/1/2001 12:00:00 AM	11/22/2010 6:24 PM
Terminations	Termination Comments	Insert				11/22/2010 6:24 PM
Terminations	Termination Date	Insert				11/22/2010 6:24 PM
Terminations	Termination Effective Date	Insert				11/22/2010 6:24 PM
Terminations	Termination Reason	Insert				11/22/2010 6:24 PM
Details	Comments Public	Insert			12/4/09 UPDATED ADDR (WAS ZIP: 30245); 12/4/09 REMOVED SHIP TO (WAS GWINNETT COUNTY HEALTH DEPARTMENT, 455 GRAYSON HWY SUITE 300, LAWRENCEVILLE, 30045); 10/06/09 ADDED SHIP TO; 8/30/06 UPDATED ADDR (WAS 316 W. PIKE ST LAWRENCEVILLE GA 30246)	11/22/2010 6:24 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History