Covered Entity Details

CH04880A JEFFERSON COMPREHENSIVE HEALTH CENTER INC (Active) - information as of 5/10/2025 10:59:22 PM

Main Details

Name

JEFFERSON COMPREHENSIVE HEALTH CENTER INC

Subdivision Name

ADAMS COUNTY FAMILY HLTH CTR

Type

HRSA-Funded Health Center

Site ID

BPS-H80-004231

340B ID

CH04880A

Grant Number

H80CS00582

Additional Details

Current Program Status

Active

Registration Date

1/13/2023

Participating Start Date

4/1/2023

Participating Approval Date

1/19/2023

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Jefferson Comprehensive Health Center, Inc.
Katrina Collins, Chief Executive Officer
(601) 786-3475

Primary Contact

Jefferson Comprehensive Health Center, Inc.
Charo Jackson, Chief Financial Officer
(601) 786-3475

Addresses

Street Address

145 HOMOCHITTO ST
NATCHEZ, MS 39120-3906

Billing Address
Same as Street Address

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
MS	08928308	1205009966

Shipping Addresses

Shipping Address 1

Jefferson Comprehensive Health Center, Inc.
405 Main Street
Fayette, MS 39069

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.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH048800	Active	BPS-H80-018842	JEFFERSON COMPREHENSIVE HEALTH CENTER INC	JEFFERSON COMPREHENSIVE HEALTH CENTER	405 Main Street	Fayette	MS
CH04880A	Active	BPS-H80-004231	JEFFERSON COMPREHENSIVE HEALTH CENTER INC	ADAMS COUNTY FAMILY HLTH CTR	145 HOMOCHITTO ST	NATCHEZ	MS
CH04880B	Active	BPS-H80-017980	JEFFERSON COMPREHENSIVE HEALTH CENTER INC	Gilmer McLaurin Elementary School	170 Sgt Prentiss Dr	Natchez	MS
CH04880C	Active	BPS-H80-029963	JEFFERSON COMPREHENSIVE HEALTH CENTER INC	Joseph L. Frazier Elementary School Clinic	1445 George F West Sr Blvd	Natchez	MS
CH04880D	Active	BPS-H80-012158	JEFFERSON COMPREHENSIVE HEALTH CENTER INC	Morgantown Middle School	101 Cottage Home Dr	Natchez	MS
CH04880E	Active	BPS-H80-030339	JEFFERSON COMPREHENSIVE HEALTH CENTER INC	Jefferson Comprehensive Health Center Medical/Dental Mobile Unit	405 Main St	Fayette	MS
CH04880F	Active	BPS-H80-003210	JEFFERSON COMPREHENSIVE HEALTH CENTER INC	JEFFERSON CNTY MID SCHOOL CLINIC	RR 2 BOX 35C	FAYETTE	MS
CH04880G	Active	BPS-H80-003001	JEFFERSON COMPREHENSIVE HEALTH CENTER INC	JEFFERSON CNTY HIGH SCHOOL CLINI	RURAL ROUTE 1; BOX 266	FAYETTE	MS

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH048800	AVITA PHARMACY 1037	AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC	2519 CANAL ST	NEW ORLEANS	LA	70119	07/01/2018	12/01/2022
CH048800	AVITA PHARMACY 1040	AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10	6100 CORPORATE BLVD STE 250	BATON ROUGE	LA	70808	07/01/2018	12/01/2022
CH048800	ERNST PHARMACY	300 HIGHLAND BLVD STE E		NATCHEZ	MS	39120-4600	04/01/2024
CH048800	FAYETTE DISCOUNT DRUGS	1418 MAIN ST	PO BOX 127	FAYETTE	MS	39069	07/23/2001	04/01/2024
CH048800	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2019
CH048800	WAL-MART PHARMACY 10-0874	314 SGT. S. PRENTISS DR		NATCHEZ	MS	39120	07/01/2019
CH048800	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2019
CH048800	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/01/2025
CH048800	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/20/2024 3:43:54 PM	2/11/2025 12:23:52 PM	2/11/2025 12:23 PM
Details	Last Recertification Date	Update	Recertification		2/20/2024 3:43:54 PM	2/20/2024 3:43 PM
Details	State	Update		Approved	Active	4/1/2023 12:01 AM
Contacts	Authorizing Official	Update	New Registration	Collins, Katrina CEO Jefferson Comprehensive Health Center, Inc. 6017863475	Collins, Katrina Chief Executive Officer Jefferson Comprehensive Health Center, Inc. 6017863475	1/19/2023 2:54 PM
Contacts	Signed By	Insert	New Registration		Collins, Katrina Chief Executive Officer Jefferson Comprehensive Health Center, Inc. 6017863475	1/19/2023 2:54 PM
Details	340B ID	Update	New Registration		CH04880A	1/19/2023 2:54 PM
Dates	Participating Approval Date	Update	New Registration		1/19/2023 2:54:30 PM	1/19/2023 2:54 PM
Details	State	Update	New Registration	Pending	Approved	1/19/2023 2:54 PM
Dates	Signed By Date	Update	New Registration		1/16/2023 5:46:53 PM	1/19/2023 2:54 PM
Dates	Start Date	Update	New Registration		4/1/2023 12:00:00 AM	1/19/2023 2:54 PM
Addresses	Main Address	Insert	New Registration		145 HOMOCHITTO ST NATCHEZ, MS 39120-3906	1/13/2023 11:19 AM
Addresses	Shipping Address	Insert	New Registration		Jefferson Comprehensive Health Center, Inc. 405 Main Street Fayette, MS 39069	1/13/2023 11:19 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/13/2023 11:19 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		08928308	1/13/2023 11:19 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	1/13/2023 11:19 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1205009966	1/13/2023 11:19 AM
Medicaid Billing	NPI: State	Insert	New Registration		MS	1/13/2023 11:19 AM
Contacts	Authorizing Official	Insert	New Registration		Collins, Katrina CEO Jefferson Comprehensive Health Center, Inc. 6017863475	1/13/2023 11:19 AM
Contacts	Primary Contact	Insert	New Registration		Jackson, Charo Chief Financial Officer Jefferson Comprehensive Health Center, Inc. 6017863475	1/13/2023 11:19 AM
Details	Assistance Received From Date	Insert	New Registration			1/13/2023 11:19 AM
Details	Assistance Received To Date	Insert	New Registration			1/13/2023 11:19 AM
Details	Last Recertification Date	Insert	New Registration			1/13/2023 11:19 AM
Details	Grant Number	Insert	New Registration		H80CS00582	1/13/2023 11:19 AM
Details	340B ID	Insert	New Registration			1/13/2023 11:19 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/13/2023 11:19 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/13/2023 11:19 AM
Details	Medicare Provider Number	Insert	New Registration			1/13/2023 11:19 AM
Details	Entity Name	Insert	New Registration		JEFFERSON COMPREHENSIVE HEALTH CENTER INC	1/13/2023 11:19 AM
Details	NOFO Number	Insert	New Registration			1/13/2023 11:19 AM
Details	Program Code	Insert	New Registration		CH	1/13/2023 11:19 AM
Details	Entity Subname	Insert	New Registration		ADAMS COUNTY FAMILY HLTH CTR	1/13/2023 11:19 AM
Dates	Participating Approval Date	Insert	New Registration			1/13/2023 11:19 AM
Details	State	Insert	New Registration		Pending	1/13/2023 11:19 AM
Dates	Registration Date	Insert	New Registration		1/13/2023 11:19:03 AM	1/13/2023 11:19 AM
Dates	Signed By Date	Insert	New Registration			1/13/2023 11:19 AM
Dates	Start Date	Insert	New Registration			1/13/2023 11:19 AM
Terminations	Termination Comments	Insert	New Registration			1/13/2023 11:19 AM
Terminations	Termination Date	Insert	New Registration			1/13/2023 11:19 AM
Terminations	Termination Effective Date	Insert	New Registration			1/13/2023 11:19 AM
Terminations	Termination Reason	Insert	New Registration			1/13/2023 11:19 AM

340B Drug Pricing Program Database