Covered Entity Details

CHC24177-17 Cahaba Medical Care Foundation (Active) - information as of 6/6/2025 12:41:06 PM

Main Details

Name

Cahaba Medical Care Foundation

Subdivision Name

Cahaba Medical Care - West Blocton

Type

HRSA-Funded Health Center

Site ID

BPS-H80-032120

340B ID

CHC24177-17

Grant Number

H80CS24177

Additional Details

Current Program Status

Active

Registration Date

10/9/2021

Participating Start Date

1/1/2022

Participating Approval Date

10/13/2021

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Cahaba Medical Care
John Waits, CEO
(205) 277-2396

Primary Contact

Cahaba Medical Care Foundation
Lacy Smith, COO
(205) 926-2992

Addresses

Street Address

319 Magnolia St
West Blocton, AL 35184

Billing Address

Cahaba Medical Care Foundation
405 Belcher St
Centreville, AL 35042

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
AL	144409	1316201809

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
Contract Detail	JACK'S DISCOUNT PHARMACY	JACK'S DISCOUNT PHARMACY	23010 HIGHWAY 5 PO BOX 680	WEST BLOCTON	AL	35184-3522	10/22/2023	01/01/2024			01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC24177-00	Active	BPS-H80-012423	CAHABA MEDICAL CARE FOUNDATION	Cahaba Medical Care - Centreville Office	405 Belcher St	Centreville	AL
CHC24177-01	Active	BPS-H80-014426	CAHABA MEDICAL CARE FOUNDATION	Cahaba Medical Care - Woodstock Office	28921 Highway 5	Woodstock	AL
CHC24177-02	Active	BPS-H80-015662	CAHABA MEDICAL CARE FOUNDATION	Cahaba Medical Care - Maplesville Office	9431 Alabama 22	Maplesville	AL
CHC24177-03	Active	BPS-H80-018184	CAHABA MEDICAL CARE FOUNDATION	Cahaba Medical Care - Centreville Dental Office	260 Walnut Street	Centreville	AL
CHC24177-04	Active	BPS-H80-030174	CAHABA MEDICAL CARE FOUNDATION	Cahaba Medical Care - Bessemer Office	975 9th Ave SW Ste. 310	Bessemer	AL
CHC24177-05	Active	BPS-H80-018982	CAHABA MEDICAL CARE FOUNDATION	Cahaba Medical Care - West End Office	1308 TUSCALOOSA AVE SW	Birmingham	AL
CHC24177-06	Active	BPS-H80-019552	Cahaba Medical Care Foundation	Cahaba Medical Care - Ensley Office	1925 Avenue E	Birmingham	AL
CHC24177-07	Active	BPS-H80-022200	Cahaba Medical Care Foundation	Cahaba Medical Care - West Blocton Elementary School	828 Cahaba River Drive	West Blocton	AL
CHC24177-08	Active	BPS-H80-022198	Cahaba Medical Care Foundation	Cahaba Medical Care - Brent Elementary School	160 4th Street	Brent	AL
CHC24177-09	Active	BPS-H80-023379	Cahaba Medical Care Foundation	Cahaba Medical Care - Marion Office	1303 Washington St	Marion	AL
CHC24177-10	Active	BPS-H80-027371	Cahaba Medical Care Foundation	Cahaba Medical Care - Birmingham Dental Clinic	623 8th Ave W	Birmingham	AL
CHC24177-11	Active	BPS-H80-029586	Cahaba Medical Care Foundation	Cahaba Medical Care - CJ Donald Elementary	715 Valley Rd	Fairfield	AL
CHC24177-12	Active	BPS-H80-029585	Cahaba Medical Care Foundation	Cahaba Medical Care - Hemphill Elementary	714 12th St SW	Birmingham	AL
CHC24177-13	Active	BPS-H80-029582	Cahaba Medical Care Foundation	Cahaba Medical Care - Robinson Elementary	301 61st St	Fairfield	AL
CHC24177-14	Active	BPS-H80-029580	Cahaba Medical Care Foundation	Cahaba Medical Care - Glen Oaks Elementary	1301 Highland Dr	Fairfield	AL
CHC24177-15	Active	BPS-H80-029584	Cahaba Medical Care Foundation	Cahaba Medical Care - Fairfield	6900 Grasselli Rd	Fairfield	AL
CHC24177-16	Terminated	BPS-H80-031032	Cahaba Medical Care Foundation	Cahaba Medical Care - Birmingham Southern	900 Arkadelphia Rd Rm 240	Birmingham	AL
CHC24177-17	Active	BPS-H80-032120	Cahaba Medical Care Foundation	Cahaba Medical Care - West Blocton	319 Magnolia St	West Blocton	AL
CHC24177-18	Active	BPS-H80-032950	Cahaba Medical Care Foundation	Cahaba Medical Care – Brent	1984 Main St	Brent	AL
CHC24177-19	Active	BPS-H80-033528	Cahaba Medical Care Foundation	Cahaba Medical Care - Princeton	801 Princeton Ave SW Ste 505	Birmingham	AL
CHC24177-20	Terminated	BPS-H80-032950	Cahaba Medical Care Foundation	Cahaba Medical Care – Brent	1984 Main St	Brent	AL
CHC24177-21	Active	BPS-H80-034081	Cahaba Medical Care Foundation	Cahaba Medical Care - Camden	321 Whiskey Run Rd	Camden	AL
CHC24177-22	Active	BPS-H80-035202	Cahaba Medical Care Foundation	Cahaba Medical Care - Ability Clinic	200 Oslo Circle	Birmingham	AL
CHC24177-23	Active	BPS-H80-035603	CAHABA MEDICAL CARE	Cahaba Medical Care - Alabaster	1010 1st St N STE 350	Alabaster	AL
CHC24177-24	Active	BPS-H80-035921	CAHABA MEDICAL CARE	Cahaba Medical Care - Hope Health	4614 Carnegie Ave	Fairfield	AL
CHC24177-25	Active	BPS-H80-036639	CAHABA MEDICAL CARE	Cahaba Medical Care - Woodland Park	873 Dennison Ave SW STE 102	Birmingham	AL
CHC24177-26	Active	BPS-H80-037357	CAHABA MEDICAL CARE FOUNDATION	Cahaba Medical Care - Fairfield High Preparatory School	610 Valley Rd	Fairfield	AL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC24177-00	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2023
CHC24177-00	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2023
CHC24177-00	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2023
CHC24177-25	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/01/2024
CHC24177-15	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	01/01/2024
CHC24177-06	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/01/2024
CHC24177-00	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2023	02/26/2024
CHC24177-00	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2023
CHC24177-00	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2023
CHC24177-00	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2023
CHC24177-24	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	01/01/2024
CHC24177-22	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/01/2024
CHC24177-00	ALABAMA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04897	155 BIRMINGHAM ROAD SUITE 114	CENTREVILLE	AL	35042	01/01/2018	02/01/2020
CHC24177-00	BIRMINGHAM APOTHECARY	1032 20TH ST S		BIRMINGHAM	AL	35205-2606	07/01/2025
CHC24177-00	BROWN DRUG CO. INC. DBA MAPLESVILLE PHAR	9081 AL HIGHWAY 22	P.O. BOX 145	MAPLESVILLE	AL	36750-3221	01/01/2022
CHC24177-02	BROWN DRUG CO. INC. DBA MAPLESVILLE PHAR	9081 AL HIGHWAY 22	P.O. BOX 145	MAPLESVILLE	AL	36750-3221	01/01/2024
CHC24177-00	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2023
CHC24177-09	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	01/01/2024
CHC24177-00	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2023
CHC24177-11	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	01/01/2024
CHC24177-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2023
CHC24177-00	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2023
CHC24177-13	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	01/01/2024
CHC24177-12	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	01/01/2024
CHC24177-00	GIBSON DISCOUNT PHARMACY	1133 LOMB AVE SW		BIRMINGHAM	AL	35211-1246	01/01/2019
CHC24177-05	GIBSON DISCOUNT PHARMACY	1133 LOMB AVE SW		BIRMINGHAM	AL	35211-1246	01/01/2024
CHC24177-00	GILMER DRUG COMPANY	413 19TH STREET ENSLEY		BIRMINGHAM	AL	35218	04/01/2019	07/01/2022
CHC24177-06	GILMER DRUG COMPANY	413 19TH STREET ENSLEY		BIRMINGHAM	AL	35218	01/01/2024	07/01/2022
CHC24177-00	HINKLE PHARMACY	1090 9TH AVE SW		BESSEMER	AL	35022-4530	04/01/2019
CHC24177-10	HINKLE PHARMACY	1090 9TH AVE SW		BESSEMER	AL	35022-4530	01/01/2024
CHC24177-00	J & S DRUGS INC	1130 WALNUT ST		CENTREVILLE	AL	35042	10/01/2018
CHC24177-18	J & S DRUGS INC	1130 WALNUT ST		CENTREVILLE	AL	35042	01/01/2024
CHC24177-00	JACK'S DISCOUNT PHARMACY	JACK'S DISCOUNT PHARMACY	23010 HIGHWAY 5 PO BOX 680	WEST BLOCTON	AL	35184-3522	04/01/2019
CHC24177-17	JACK'S DISCOUNT PHARMACY	JACK'S DISCOUNT PHARMACY	23010 HIGHWAY 5 PO BOX 680	WEST BLOCTON	AL	35184-3522	01/01/2024
CHC24177-00	MONTEVALLO DRUG COMPANY	3990 HIGHWAY 25		MONTEVALLO	AL	35115-4161	04/01/2022
CHC24177-03	MONTEVALLO DRUG COMPANY	3990 HIGHWAY 25		MONTEVALLO	AL	35115-4161	01/01/2024
CHC24177-00	MOORE'S PHARMACY LLC	STE B MORGAN BLDG	3041 ENSLEY 5 POINTS W AVE	BIRMINGHAM	AL	35208-2792	04/01/2020	09/11/2020
CHC24177-15	MOORE'S PHARMACY LLC	STE B MORGAN BLDG	3041 ENSLEY 5 POINTS W AVE	BIRMINGHAM	AL	35208-2792	01/01/2024	09/01/2020
CHC24177-00	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2025
CHC24177-00	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	01/01/2025
CHC24177-00	ROCK CREEK PHARMACY	6817 WARRIOR RIVER RD		BESSEMER	AL	35023-5601	10/01/2024
CHC24177-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2019
CHC24177-00	WAL-MART PHARMACY 10-0424	1415 7TH ST. SOUTH		CLANTON	AL	35045	10/01/2024
CHC24177-00	WAL-MART PHARMACY 10-0425	10675 HIGHWAY 5		BRENT	AL	35034	01/01/2017
CHC24177-08	WAL-MART PHARMACY 10-0425	10675 HIGHWAY 5		BRENT	AL	35034	01/01/2024
CHC24177-00	WAL-MART PHARMACY 10-0700	1501 HWY 14 EAST		SELMA	AL	36703	10/01/2024
CHC24177-00	WAL-MART PHARMACY 10-0715	1501 SKYLAND BLVD EAST		TUSCALOOSA	AL	35405	04/01/2020
CHC24177-07	WAL-MART PHARMACY 10-0715	1501 SKYLAND BLVD EAST		TUSCALOOSA	AL	35405	01/01/2024
CHC24177-00	WAL-MART PHARMACY 10-0764	750 ACADEMY DR		BESSEMER	AL	35020	01/01/2017
CHC24177-04	WAL-MART PHARMACY 10-0764	750 ACADEMY DR		BESSEMER	AL	35020	01/01/2024
CHC24177-00	WAL-MART PHARMACY 10-1201	890 ODUM RD		GARDENDALE	AL	35071	10/01/2024
CHC24177-00	WAL-MART PHARMACY 10-2306	5710 MCFARLAND BLVD		NORTHPORT	AL	35476	10/01/2024
CHC24177-00	WAL-MART PHARMACY 10-2723	690 HIGHWAY 78		SUMITON	AL	35148	10/01/2024
CHC24177-00	WAL-MART PHARMACY 10-3271	5100 HIGHWAY 31		CALERA	AL	35040	10/01/2024
CHC24177-00	WAL-MART PHARMACY 10-4497	1007 RED FARMER DRIVE		HUEYTOWN	AL	35023	04/01/2020
CHC24177-16	WAL-MART PHARMACY 10-4497	1007 RED FARMER DRIVE		HUEYTOWN	AL	35023	01/01/2024	01/01/2025
CHC24177-00	WAL-MART PHARMACY 10-4504	312 PALISADES BOULEVARD		BIRMINGHAM	AL	35209	10/01/2024
CHC24177-00	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/01/2024	01/31/2025
CHC24177-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2019
CHC24177-00	WALMART PHARMACY #10-5248	1660 MCFARLAND BOULEVARD		NORTHPORT	AL	35476	10/01/2024
CHC24177-00	WALMART PHARMACY 10-1158	2473 HACKWORTH RD		ADAMSVILLE	AL	35214	10/01/2024
CHC24177-00	WALMART PHARMACY 10-4756	9085 HWY 119		ALABASTER	AL	35007	10/01/2024
CHC24177-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CHC24177-00	WALMART PHARMACY 10-5256	4201 HARGROVE RD E		TUSCALOOSA	AL	35405	10/01/2024
CHC24177-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CHC24177-00	WHITAKER DRUGS	20 CAMDEN BYP		CAMDEN	AL	36726	10/01/2022
CHC24177-21	WHITAKER DRUGS	20 CAMDEN BYP		CAMDEN	AL	36726	01/01/2024
CHC24177-00	WOODSTOCK DRUG	28891 HIGHWAY 5	P.O. BOX 280	WOODSTOCK	AL	35188	10/01/2018
CHC24177-01	WOODSTOCK DRUG	28891 HIGHWAY 5	P.O. BOX 280	WOODSTOCK	AL	35188	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/2/2024 2:39:54 PM	2/12/2025 10:08:08 PM	2/12/2025 10:08 PM
Details	Last Recertification Date	Update	Recertification	2/18/2023 10:51:25 AM	2/2/2024 2:39:54 PM	2/2/2024 2:39 PM
Details	Last Recertification Date	Update	Recertification	2/25/2022 11:21:21 AM	2/18/2023 10:51:25 AM	2/18/2023 10:51 AM
Addresses	Billing Address	Insert	Recertification		Cahaba Medical Care Foundation 405 Belcher St Centreville, AL 35042	2/25/2022 11:21 AM
Details	Last Recertification Date	Update	Recertification		2/25/2022 11:21:21 AM	2/25/2022 11:21 AM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Waits, John CEO Cahaba Medical Care 2052772396	10/13/2021 9:35 AM
Details	340B ID	Update	New Registration		CHC24177-17	10/13/2021 9:35 AM
Dates	Participating Approval Date	Update	New Registration		10/13/2021 9:35:39 AM	10/13/2021 9:35 AM
Details	State	Update	New Registration	Pending	Approved	10/13/2021 9:35 AM
Dates	Signed By Date	Update	New Registration		10/12/2021 10:44:27 AM	10/13/2021 9:35 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	10/13/2021 9:35 AM
Addresses	Main Address	Insert	New Registration		319 Magnolia St West Blocton, AL 35184	10/9/2021 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/9/2021 1:36 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		144409	10/9/2021 1:36 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	10/9/2021 1:36 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1316201809	10/9/2021 1:36 PM
Medicaid Billing	NPI: State	Insert	New Registration		AL	10/9/2021 1:36 PM
Contacts	Authorizing Official	Insert	New Registration		Waits, John CEO Cahaba Medical Care 2052772396	10/9/2021 1:36 PM
Contacts	Primary Contact	Insert	New Registration		Smith, Lacy COO Cahaba Medical Care Foundation 2059262992	10/9/2021 1:36 PM
Details	Assistance Received From Date	Insert	New Registration			10/9/2021 1:36 PM
Details	Assistance Received To Date	Insert	New Registration			10/9/2021 1:36 PM
Details	Last Recertification Date	Insert	New Registration			10/9/2021 1:36 PM
Details	Grant Number	Insert	New Registration		H80CS24177	10/9/2021 1:36 PM
Details	340B ID	Insert	New Registration			10/9/2021 1:36 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/9/2021 1:36 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/9/2021 1:36 PM
Details	Medicare Provider Number	Insert	New Registration			10/9/2021 1:36 PM
Details	Entity Name	Insert	New Registration		Cahaba Medical Care Foundation	10/9/2021 1:36 PM
Details	NOFO Number	Insert	New Registration			10/9/2021 1:36 PM
Details	Program Code	Insert	New Registration		CH	10/9/2021 1:36 PM
Details	Entity Subname	Insert	New Registration		Cahaba Medical Care - West Blocton	10/9/2021 1:36 PM
Dates	Participating Approval Date	Insert	New Registration			10/9/2021 1:36 PM
Details	State	Insert	New Registration		Pending	10/9/2021 1:36 PM
Dates	Registration Date	Insert	New Registration		10/9/2021 1:36:05 PM	10/9/2021 1:36 PM
Dates	Signed By Date	Insert	New Registration			10/9/2021 1:36 PM
Dates	Start Date	Insert	New Registration			10/9/2021 1:36 PM
Terminations	Termination Comments	Insert	New Registration			10/9/2021 1:36 PM
Terminations	Termination Date	Insert	New Registration			10/9/2021 1:36 PM
Terminations	Termination Effective Date	Insert	New Registration			10/9/2021 1:36 PM
Terminations	Termination Reason	Insert	New Registration			10/9/2021 1:36 PM

340B Drug Pricing Program Database