Covered Entity Details

CH04479N Primary Health Care Center Of Dade, Inc. (Active) - information as of 4/25/2025 12:00:38 AM

Main Details

Name

Primary Health Care Center Of Dade, Inc.

Subdivision Name

Primary Healthcare Center at Rossville Elementary - SBHC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-035064

340B ID

CH04479N

Grant Number

H80CS00649

Additional Details

Current Program Status

Active

Registration Date

10/5/2022

Participating Start Date

1/1/2023

Participating Approval Date

10/7/2022

Last Recertification Date

3/5/2025

Contacts

Authorizing Official

Primary Healthcare Center
Richard Christman, Chief Executive Officer
(706) 956-2665 Ext: 8549

Primary Contact

Primary Health Care Center of Dade, Inc.
Melanie Forsythe, COO
(706) 620-4494 Ext: 8541

Addresses

Street Address

1250 Wilson Rd
Rossville, GA 30741-1736

Billing Address

Primary Healthcare Centers
100 Mitchell Rd
Fort Oglethorpe, GA 30742

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
GA	003283513A	1134857162
TN		1134857162

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	WAL-MART PHARMACY 10-3660	3550 CUMMINGS HIGHWAY		CHATTANOOGA(SW)	TN	37419	01/16/2024	04/01/2024			04/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH044790	Active	BPS-H80-002107	PRIMARY HEALTH CARE CENTER OF DADE, INC.	PRIMARY HEALTH CARE CENTER TRENTON	13570 N Main St	Trenton	GA
CH04479A	Terminated	BPS-H80-024685	PRIMARY HEALTH CARE CENTER OF DADE, INC.	PRIMARY HEALTH CARE CENTER-Rossville at Fairview	205 Jenkins Road	Rossville	GA
CH04479B	Active	BPS-H80-012396	PRIMARY HEALTH CARE CENTER OF DADE, INC.	Tiger Creek Elementary School	134 Rhea Mcclanahan Dr	Tunnel Hill	GA
CH04479C	Terminated	BPS-H80-012906	PRIMARY HEALTH CARE CENTER OF DADE, INC.	Primary Health Care Center Cedartown	118 E GIRARD AVE	CEDARTOWN	GA
CH04479D	Terminated	BPS-H80-022339	PRIMARY HEALTH CARE CENTER OF DADE, INC.	Primary Healthcare Centers-Fairview (Administrative Only)	205 Jenkins Road	Rossville	GA
CH04479E	Active	BPS-H80-015041	PRIMARY HEALTH CARE CENTER OF DADE, INC.	Gilbert Elementary SBHC	87 S BURNT MILL RD	LA FAYETTE	GA
CH04479F	Active	BPS-H80-014172	PRIMARY HEALTH CARE CENTER OF DADE, INC.	Primary Health Care Center Summerville	11638 HIGHWAY 27	SUMMERVILLE	GA
CH04479G	Terminated	BPS-H80-015046	PRIMARY HEALTH CARE CENTER OF DADE, INC.	School Based Dental Mobile Unit	87 S BURNT MILL RD	LA FAYETTE	GA
CH04479H	Active	BPS-H80-031882	Primary Health Care Center Of Dade, Inc.	Primary Healthcare Center Abbington at Linwood	10 Probasco St # 214	La Fayette	GA
CH04479J	Terminated	BPS-H80-032377	Primary Health Care Center Of Dade, Inc.	SBHC - Ringgold Middle & High School	29 Tiger Trl	Ringgold	GA
CH04479K	Terminated	BPS-H80-034176	Primary Health Care Center Of Dade, Inc.	Primary Health Care Center Rome	1400 Crane St SW	Rome	GA
CH04479L	Terminated	BPS-H80-034773	Primary Health Care Center Of Dade, Inc.	Primary Healthcare Center Administration	25 Quartermaster Cir STE 25	Fort Oglethorpe	GA
CH04479M	Active	BPS-H80-035568	Primary Health Care Center Of Dade, Inc.	Primary Healthcare Center, Ft. Oglethorpe	2009 Old Lafayette Rd	Fort Oglethorpe	GA
CH04479N	Active	BPS-H80-035064	Primary Health Care Center Of Dade, Inc.	Primary Healthcare Center at Rossville Elementary - SBHC	1250 Wilson Rd	Rossville	GA
CH04479P	Active	BPS-H80-035037	Primary Health Care Center Of Dade, Inc.	Primary Healthcare Center at Rossville Middle School - SBHC	316 Bull Dog Trl	Rossville	GA
CH04479Q	Active	BPS-H80-033806	Primary Health Care Center Of Dade, Inc.	Primary Healthcare Center, Mitchell Road	100 Mitchell Rd	Fort Oglethorpe	GA
CH04479R	Approved	BPS-H80-039328	PRIMARY HEALTH CARE CENTER OF DADE, INC.	College and Career Academy, SBHC	182 Catoosa Cir	Ringgold	GA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH044790	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2025
CH044790	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	07/01/2017
CH044790	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	07/01/2017
CH044790	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2022
CH044790	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2022
CH044790	FOOD CITY PHARMACY #233	112 CRIMSON DRIVE		TRENTON	GA	30752	10/01/2022
CH04479E	FOOD CITY PHARMACY #233	112 CRIMSON DRIVE		TRENTON	GA	30752	04/01/2024
CH044790	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03760	887 BATTLEFIELD PARKWAY	FT OGLETHORPE	GA	30742	04/01/2022
CH044790	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04582	9849 ROME BLVD.	SUMMERVILLE	GA	30747	04/01/2022
CH044790	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05356	511 N. MAIN ST.	CEDARTOWN	GA	30125	04/01/2022
CH044790	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07223	807 N. MAIN ST.	LAFAYETTE	GA	30728	04/01/2022
CH044790	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07745	6945 NASHVILLE STREET	RINGGOLD	GA	30736	04/01/2022
CH044790	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07755	5431 HIGHWAY 136	TRENTON	GA	30752-2932	04/01/2022
CH044790	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07885	4825 BATTLEFIELD PARKWAY	RINGGOLD	GA	30736	04/01/2022
CH04479G	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03760	887 BATTLEFIELD PARKWAY	FT OGLETHORPE	GA	30742	04/01/2024	04/01/2025
CH04479M	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07745	6945 NASHVILLE STREET	RINGGOLD	GA	30736	04/01/2024
CH04479P	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07223	807 N. MAIN ST.	LAFAYETTE	GA	30728	04/01/2024
CH04479Q	GEORGIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04582	9849 ROME BLVD.	SUMMERVILLE	GA	30747	04/01/2024
CH044790	LOOKOUT MOUNTAIN COMMUNITY	SERVICES	1875 FANT DRIVE	FORT OGLETHORPE	GA	30742	10/01/2013	04/12/2016
CH04479A	MEDITHRIFT PHARMACY INC	324 WEST PATTON STREET	P.O. BOX 791	LAFAYETTE	GA	30728	02/09/2012	09/15/2021
CH044790	MEDITHRIFT PHARMACY INC	324 WEST PATTON STREET	P.O. BOX 791	LAFAYETTE	GA	30728	07/01/2022
CH04479F	MEDITHRIFT PHARMACY INC	324 WEST PATTON STREET	P.O. BOX 791	LAFAYETTE	GA	30728	04/01/2024
CH044790	PONDERS PHARMACY		11997 SOUTH MAIN ST PO BOX 849	TRENTON	GA	30752	02/02/2012	04/12/2016
CH044790	PRICE PHARMACY INC	4655 HIGHWAY 136	PO BOX 99	TRENTON	GA	30752	02/02/2012	04/12/2016
CH044790	PRICE RINGGOLD DRUGS INC	7566 NASHVILLE ST	P.O. BOX 339	RINGGOLD	GA	30736	02/02/2012	04/12/2016
CH044790	ROCKY TOP PHARMACY INC DBA	LONGLEY PHARMACY	785 CHICKAMAUGA AVE	ROSSVILLE	GA	30741	02/02/2012	04/12/2016
CH044790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03734	5011-A STATE STREET	CHATTANOOGA	TN	37407	04/01/2022	08/10/2022
CH044790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY #3963	321 BROWNS FERRY RD	CHATTANOOGA	TN	37419	10/01/2022	12/05/2023
CH044790	TENNESSEE CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05378	3800 TENNESSEE AVE.	CHATTANOOGA	TN	37409	10/01/2024
CH044790	TRENTON PHARMACY	NARAYAN 56 PHARMACY LLC	11969 S MAIN ST	TRENTON	GA	30752	07/01/2025
CH044790	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2022
CH044790	WAL-MART PHARMACY 10-0727	1585 ROME HWY		CEDARTOWN	GA	30125	07/01/2022
CH044790	WAL-MART PHARMACY 10-0756	13427 HIGHWAY 27		TRION	GA	30753	07/01/2022
CH04479K	WAL-MART PHARMACY 10-0756	13427 HIGHWAY 27		TRION	GA	30753	04/01/2024	04/01/2024
CH044790	WAL-MART PHARMACY 10-1458	3040 BATTLEFIELD PKWY		FORT OGLETHORPE	GA	30742	04/01/2014	04/12/2016
CH044790	WAL-MART PHARMACY 10-1458	3040 BATTLEFIELD PKWY		FORT OGLETHORPE	GA	30742	07/01/2022
CH04479H	WAL-MART PHARMACY 10-1458	3040 BATTLEFIELD PKWY		FORT OGLETHORPE	GA	30742	04/01/2024
CH044790	WAL-MART PHARMACY 10-2988	2625 NO HWY 27		LAFAYETTE	GA	30728	07/01/2022
CH04479B	WAL-MART PHARMACY 10-2988	2625 NO HWY 27		LAFAYETTE	GA	30728	04/01/2024
CH044790	WAL-MART PHARMACY 10-3660	3550 CUMMINGS HIGHWAY		CHATTANOOGA(SW)	TN	37419	07/01/2022
CH04479N	WAL-MART PHARMACY 10-3660	3550 CUMMINGS HIGHWAY		CHATTANOOGA(SW)	TN	37419	04/01/2024
CH044790	WAL-MART PHARMACY 10-4409	1801 NATHAN DEAN BYPASS		ROCKMART	GA	30153	07/01/2024
CH044790	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2022
CH044790	WALGREEN CO	DBA: WALGREENS #10247	5075 ALABAMA HWY	RINGGOLD	GA	30736	07/01/2013
CH044790	WALGREEN CO.	DBA: WALGREENS # 03537	5301 RINGGOLD RD	EAST RIDGE	TN	37412	07/01/2013
CH044790	WALGREEN CO.	DBA: WALGREENS # 05954	1247 WALNUT AVE W	DALTON	GA	30720	07/01/2013
CH044790	WALGREEN CO.	DBA: WALGREENS # 06143	3550 BROAD ST	CHATTANOOGA	TN	37409	07/01/2013
CH044790	WALGREEN CO.	DBA: WALGREENS # 07312	4810 ROSSVILLE BLVD	CHATTANOOGA	TN	37407-3524	07/01/2013	04/09/2024
CH044790	WALGREEN CO.	DBA: WALGREENS # 07567	1228 BATTLEFIELD PKWY	FT OGLETHORPE	GA	30742-4008	07/01/2013
CH044790	WALGREEN CO.	DBA: WALGREENS #12921	3625 BATTLEFIELD PKWY	FORT OGLETHORPE	GA	30742	07/01/2013
CH044790	WALGREEN CO.	DBA: WALGREENS # 03535	2289 GUNBARREL	CHATTANOOGA	TN	37421	01/01/2015
CH044790	WALGREEN CO.	DBA: WALGREENS # 06777	8714 E BRAINERD ROAD	CHATTANOOGA	TN	37421	01/01/2015
CH044790	WALGREEN CO.	DBA: WALGREENS # 07199	701 MARTHA BERRY BLVD NW	ROME	GA	30165-1637	01/01/2015
CH044790	WALGREEN CO.	DBA: WALGREENS #11685	201 PACIFIC AVENUE	BREMEN	GA	30110	01/01/2015
CH044790	WALGREEN CO.	WALGREENS #17083	633 N MAIN ST	CEDARTOWN	GA	30125	01/01/2020
CH044790	WALGREEN CO.	DBA: WALGREENS #10798	1101 N THIRD AVENUE	CHATSWORTH	GA	30705	01/01/2022
CH044790	WALGREEN CO.	DBA: WALGREENS #11160	9307 LEE HWY.	OOLTEWAH	TN	37363	01/01/2022
CH044790	WALGREEN CO.	DBA: WALGREENS #11732	2900 PAUL HUFF PKWY. NW	CLEVELAND	TN	37312-3076	01/01/2022
CH044790	WALGREEN CO.	WALGREENS #17232	1320 CLEVELAND HWY	DALTON	GA	30721	01/01/2022
CH044790	WALGREEN CO.	WALGREENS #17271	140 FELTON DRIVE STE B	ROCKMART	GA	30153	01/01/2022
CH044790	WALGREEN CO.	WALGREENS #19113	2104 MCCALLIE AVENUE	CHATTANOOGA	TN	37404	01/01/2022	02/27/2024
CH044790	WALMART PHARMACY #10-3635	1155 BATTLEFIELD PKWY		FORT OGLETHORPE	GA	30742	07/01/2022
CH04479C	WALMART PHARMACY #10-3635	1155 BATTLEFIELD PKWY		FORT OGLETHORPE	GA	30742	04/01/2024	07/01/2024
CH044790	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH044790	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/9/2024 3:09:13 PM	3/5/2025 9:31:48 AM	3/5/2025 9:31 AM
Contacts	Authorizing Official	Update	AO Change Request	ALLEN, DIANA U. CEO Primary Health Care Center of Dade, Inc. 7066204494-8549	Christman, Richard Chief Executive Officer Primary Healthcare Center 7069562665-8549	2/28/2025 1:46 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1510361 (TN)		2/9/2024 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/9/2024 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		003283513A	2/9/2024 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	2/9/2024 3:09 PM
Details	Last Recertification Date	Update	Recertification	2/1/2023 2:59:09 PM	2/9/2024 3:09:13 PM	2/9/2024 3:09 PM
Details	Last Recertification Date	Update	Recertification		2/1/2023 2:59:09 PM	2/1/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/4/2023 1:02 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1510361	1/4/2023 1:02 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	1/4/2023 1:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1134857162	1/4/2023 1:02 PM
Medicaid Billing	NPI: State	Insert	Change Request		GA	1/4/2023 1:02 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1134857162	1/4/2023 1:02 PM
Medicaid Billing	NPI: State	Insert	Change Request		TN	1/4/2023 1:02 PM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		ALLEN, DIANA U. CEO Primary Health Care Center of Dade, Inc. 7066204494-8549	10/7/2022 7:42 AM
Details	340B ID	Update	New Registration		CH04479N	10/7/2022 7:42 AM
Dates	Participating Approval Date	Update	New Registration		10/7/2022 7:42:04 AM	10/7/2022 7:42 AM
Details	State	Update	New Registration	Pending	Approved	10/7/2022 7:42 AM
Dates	Signed By Date	Update	New Registration		10/6/2022 3:17:34 PM	10/7/2022 7:42 AM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	10/7/2022 7:42 AM
Addresses	Main Address	Insert	New Registration		1250 Wilson Rd Rossville, GA 30741-1736	10/5/2022 12:25 PM
Addresses	Billing Address	Insert	New Registration		Primary Healthcare Centers 100 Mitchell Rd Fort Oglethorpe, GA 30742	10/5/2022 12:25 PM
Contacts	Primary Contact	Insert	New Registration		Forsythe, Melanie COO Primary Health Care Center of Dade, Inc. 7066204494-8541	10/5/2022 12:25 PM
Contacts	Authorizing Official	Insert	New Registration		ALLEN, DIANA U. CEO Primary Health Care Center of Dade, Inc. 7066204494-8549	10/5/2022 12:25 PM
Details	Assistance Received From Date	Insert	New Registration			10/5/2022 12:25 PM
Details	Assistance Received To Date	Insert	New Registration			10/5/2022 12:25 PM
Details	Last Recertification Date	Insert	New Registration			10/5/2022 12:25 PM
Details	Grant Number	Insert	New Registration		H80CS00649	10/5/2022 12:25 PM
Details	340B ID	Insert	New Registration			10/5/2022 12:25 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/5/2022 12:25 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/5/2022 12:25 PM
Details	Medicare Provider Number	Insert	New Registration			10/5/2022 12:25 PM
Details	Entity Name	Insert	New Registration		Primary Health Care Center Of Dade, Inc.	10/5/2022 12:25 PM
Details	NOFO Number	Insert	New Registration			10/5/2022 12:25 PM
Details	Program Code	Insert	New Registration		CH	10/5/2022 12:25 PM
Details	Entity Subname	Insert	New Registration		Primary Healthcare Center at Rossville Elementary - SBHC	10/5/2022 12:25 PM
Dates	Participating Approval Date	Insert	New Registration			10/5/2022 12:25 PM
Details	State	Insert	New Registration		Pending	10/5/2022 12:25 PM
Dates	Registration Date	Insert	New Registration		10/5/2022 12:25:36 PM	10/5/2022 12:25 PM
Dates	Signed By Date	Insert	New Registration			10/5/2022 12:25 PM
Dates	Start Date	Insert	New Registration			10/5/2022 12:25 PM
Terminations	Termination Comments	Insert	New Registration			10/5/2022 12:25 PM
Terminations	Termination Date	Insert	New Registration			10/5/2022 12:25 PM
Terminations	Termination Effective Date	Insert	New Registration			10/5/2022 12:25 PM
Terminations	Termination Reason	Insert	New Registration			10/5/2022 12:25 PM

340B Drug Pricing Program Database