Covered Entity Details

CAH251302-24 BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL (Active) - information as of 4/27/2025 1:51:08 AM

Main Details

Name

BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL

Subdivision Name

MRH Medical Group, Corinth Alcorn Dr.

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH251302-24

Medicare Provider Number

251302

Outpatient Facility Provider Number

258639

Additional Details

Current Program Status

Active

Registration Date

10/14/2021

Participating Start Date

1/1/2022

Participating Approval Date

11/5/2021

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Boa Vida Hospital of Aberdeen LLC., dba Monroe Regional Hospital
Chris Chandler, CEO
(662) 369-2455

Primary Contact

Boa Vida Hospital of Aberdeen LLC., dba Monroe Regional Hospital
Lauren Wrighton Murray, 340B Program Coordinator
(662) 319-2074

Addresses

Street Address

508 Alcorn Drive
Corinth, MS 38834-9392

Billing Address

Boa Vida Healthcare, LLC
Attn: Accounts Payable
10996 Four Seasons Place
Suite 100C
Crown Point, IN 46307-7762

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	05306316	1063076511

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
CAH251302-01	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	NINA JURNEY CLINIC	502 JACKSON ST.	ABERDEEN	MS	Active
CAH251302-02	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	Monroe Regional Hospital Medical Group Chestnut	502 JACKSON ST	ABERDEEN	MS	Active
CAH251302-03	Child	CAH	PIONEER HEALTH SERVICES OF MONROE COUNTY, INC. D/B/A PIONEER COMMUNITY HOSPITAL	PIONEER FAMILY MEDICAL OF AMORY	1506 HWY 278 E.	AMORY	MS	Terminated
CAH251302-05	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	Monroe Regional Hospital Medical Group Hamilton	40128 HAMILTON RD.	HAMILTON	MS	Active
CAH251302-06	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	Monroe Regional Hospital Medical Group	502 JACKSON ST	ABERDEEN	MS	Active
CAH251302-07	Child	CAH	PIONEER COMMUNITY HOSP OF ABERDEEN	Pioneer Outpatient Behavioral Health of Amory	60387 Cotton Gin Port Road	Amory	MS	Terminated
CAH251302-08	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	Monroe Regional Hospital Outpt Behavorial Health of Aberdeen	405 S. Chestnut Street	Aberdeen	MS	Active
CAH251302-09	Child	CAH	PIONEER COMMUNITY HOSP OF ABERDEEN	Pioneer Outpatient Behavioral Health of Columbus	2625 5th Street North	Columbus	MS	Terminated
CAH251302-10	Child	CAH	PIONEER COMMUNITY HOSP OF ABERDEEN	Pioneer Outpatient Behavioral Health of Starkville	106 Strange Road	Starkville	MS	Terminated
CAH251302-11	Child	CAH	PIONEER HEALTH SERVICES OF MONROE COUNTY, INC. D/B/A PIONEER COMMUNITY HOSPITAL	Pioneer Outpatient Behavioral Health of Okolona	253 West Main Street	Okolona	MS	Terminated
CAH251302-12	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Aberdeen	502 Jackson St	Aberdeen	MS	Terminated
CAH251302-13	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Starkville	900 Stark Rd	Starkville	MS	Terminated
CAH251302-14	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Chestnut	502 Jackson St	Aberdeen	MS	Terminated
CAH251302-15	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Columbus 5th St	2200 5th St. N	Columbus	MS	Terminated
CAH251302-16	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Columbus Women's Wellness	505 Willowbrook Rd	Columbus	MS	Terminated
CAH251302-17	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial - Hamilton	40128 Hamilton Rd	Hamilton	MS	Terminated
CAH251302-18	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Commercial Clinic - Jurney	502 Jackson St.	Aberdeen	MS	Terminated
CAH251302-19	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group Columbus 5th Street	2200 5th Street North	Columbus	MS	Active
CAH251302-20	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group Columbus Women's Wellness	505 Willowbrook Road	Columbus	MS	Active
CAH251302-21	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group Starkville	807 MS-12 W	Starkville	MS	Active
CAH251302-22	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, Nettleton	1495 Maple Rd.	Nettleton	MS	Active
CAH251302-23	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, Sherman	670 Hwy 178 W, Suite 5	Sherman	MS	Active
CAH251302-24	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, Corinth Alcorn Dr.	508 Alcorn Drive	Corinth	MS	Active
CAH251302-25	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, GSV Houlka	400 3rd Avenue Hwy 32 West	Houlka	MS	Active
CAH251302-26	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, West Point OB/GYN & Primary Care	116 Medical Center Dr.	West Point	MS	Active
CAH251302-27	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group, Belmont	19 3rd Street	Belmont	MS	Active
CAH251302-28	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Premier Diabetes and Medical Clinic	2394 McCullough Blvd.	Belden	MS	Active
CAH251302-29	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Acute Care and Family Clinic of Pontotoc	351 Peoples Drive	Pontotoc	MS	Active
CAH251302-30	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - East Main Family Medical	1424 E. Main St.	Tupelo	MS	Active
CAH251302-31	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Verona Family Medicine and Urgent Care	5024 Raymond Ave.	Tupelo	MS	Active
CAH251302-32	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Horn Family Medical Clinic	457 E. Madison Street	Houston	MS	Active
CAH251302-33	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Brown Medical Clinic	401 S. Chestnut St.	Aberdeen	MS	Active
CAH251302-34	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Rice Family Medical Clinic	120 Burke Calhoun City Rd.	Calhoun City	MS	Active
CAH251302-35	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRH Medical Group - Potter Family Clinic	1462A Hwy 1 South	Greenville	MS	Active
CAH251302-36	Child	CAH	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	MRHMG - Caretime Medical Clinic	1506 US 278A	Amory	MS	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 10:57:06 AM	8/12/2024 3:40:52 PM	8/12/2024 3:40 PM
Details	Last Recertification Date	Update	Recertification	8/31/2022 11:55:09 AM	8/17/2023 10:57:06 AM	8/17/2023 10:57 AM
Details	Entity Subname	Update	Change Request	MRH Medical Group, Corinth Alcorn Dr. - MRH Medical Group, Corinth Alcorn Dr.	MRH Medical Group, Corinth Alcorn Dr.	7/14/2023 6:33 AM
Addresses	Billing Address	Update	Group Change Request	Boa Vida Healthcare, LLC 10757 Randolph Street Crown Point, IN 46307	Boa Vida Healthcare, LLC Attn: Accounts Payable 10996 Four Seasons Place Suite 100C Crown Point, IN 46307-7762	7/12/2023 3:11 PM
Details	Last Recertification Date	Update	Recertification		8/31/2022 11:55:09 AM	8/31/2022 11:55 AM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Chandler, Chris CEO Boa Vida Hospital of Aberdeen LLC., dba Monroe Regional Hospital 6623692455	11/5/2021 10:29 AM
Details	340B ID	Update	New Registration		CAH251302-24	11/5/2021 10:29 AM
Details	Entity Name	Update	New Registration	MONROE REGIONAL HOSPITAL	BOA VIDA HOSPITAL OF ABERDEEN, MS, LLC, D/B/A MONROE REGIONAL HOSPITAL	11/5/2021 10:29 AM
Details	Entity Subname	Update	New Registration	MRH Medical Group, Corinth Alcorn Dr.	MRH Medical Group, Corinth Alcorn Dr. - MRH Medical Group, Corinth Alcorn Dr.	11/5/2021 10:29 AM
Dates	Participating Approval Date	Update	New Registration		11/5/2021 10:29:36 AM	11/5/2021 10:29 AM
Details	State	Update	New Registration	Pending	Approved	11/5/2021 10:29 AM
Dates	Signed By Date	Update	New Registration		11/4/2021 4:29:20 PM	11/5/2021 10:29 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	11/5/2021 10:29 AM
Addresses	Main Address	Insert	New Registration		508 Alcorn Drive Corinth, MS 38834-9392	10/14/2021 5:51 PM
Addresses	Billing Address	Insert	New Registration		Boa Vida Healthcare, LLC 10757 Randolph Street Crown Point, IN 46307	10/14/2021 5:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/14/2021 5:51 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		05306316	10/14/2021 5:51 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	10/14/2021 5:51 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1063076511	10/14/2021 5:51 PM
Medicaid Billing	NPI: State	Insert	New Registration		MS	10/14/2021 5:51 PM
Contacts	Authorizing Official	Insert	New Registration		Chandler, Chris CEO Boa Vida Hospital of Aberdeen LLC., dba Monroe Regional Hospital 6623692455	10/14/2021 5:51 PM
Contacts	Primary Contact	Insert	New Registration		Murray, Lauren Wrighton 340B Program Coordinator Boa Vida Hospital of Aberdeen LLC., dba Monroe Regional Hospital 6623192074	10/14/2021 5:51 PM
Details	Assistance Received From Date	Insert	New Registration			10/14/2021 5:51 PM
Details	Assistance Received To Date	Insert	New Registration			10/14/2021 5:51 PM
Details	Last Recertification Date	Insert	New Registration			10/14/2021 5:51 PM
Details	Grant Number	Insert	New Registration			10/14/2021 5:51 PM
Details	340B ID	Insert	New Registration			10/14/2021 5:51 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/14/2021 5:51 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/14/2021 5:51 PM
Details	Medicare Provider Number	Insert	New Registration		251302	10/14/2021 5:51 PM
Details	Entity Name	Insert	New Registration		MONROE REGIONAL HOSPITAL	10/14/2021 5:51 PM
Details	NOFO Number	Insert	New Registration			10/14/2021 5:51 PM
Details	Program Code	Insert	New Registration		CAH	10/14/2021 5:51 PM
Details	Entity Subname	Insert	New Registration		MRH Medical Group, Corinth Alcorn Dr.	10/14/2021 5:51 PM
Dates	Participating Approval Date	Insert	New Registration			10/14/2021 5:51 PM
Details	State	Insert	New Registration		Pending	10/14/2021 5:51 PM
Dates	Registration Date	Insert	New Registration		10/14/2021 5:51:29 PM	10/14/2021 5:51 PM
Dates	Signed By Date	Insert	New Registration			10/14/2021 5:51 PM
Dates	Start Date	Insert	New Registration			10/14/2021 5:51 PM
Terminations	Termination Comments	Insert	New Registration			10/14/2021 5:51 PM
Terminations	Termination Date	Insert	New Registration			10/14/2021 5:51 PM
Terminations	Termination Effective Date	Insert	New Registration			10/14/2021 5:51 PM
Terminations	Termination Reason	Insert	New Registration			10/14/2021 5:51 PM