340B Drug Pricing Program Database


CH04577AQ SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. (Active) - information as of 6/4/2025 12:07:48 PM

Main Details
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
Oak Grove Longleaf
HRSA-Funded Health Center
BPS-H80-035506
CH04577AQ
H80CS00610


Additional Details
Active
10/11/2023
1/1/2024
10/20/2023
2/14/2025

Contacts

SeMRHI
Janice Robinson, CEO
(601) 545-3700

Southeast Mississippi Rural Health Initiative, Inc.
Charnay Ingram, Director of Pharmacy, PharmD
(601) 544-4163 Ext: 3902

Addresses

5279 W 4th St
Hattiesburg, MS 39402-9700

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
MS2000021751053985226
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH045770ActiveBPS-H80-000890Southeast Mississippi Rural Health Initiative, Inc.SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.5488 U S Highway 49 HattiesburgMS
CH04577AActiveBPS-H80-001021SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.SUMRALL FAMILY HEALTH CENTER1016 HIGHWAY 42 SUMRALLMS
CH04577AAActiveBPS-H80-036072SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Sumrall High School184 Center Avenue SumrallMS
CH04577ABActiveBPS-H80-035507SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Sumrall Elementary School198 Todd Rd SumrallMS
CH04577ACActiveBPS-H80-035222SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Sumrall Middle School1217 Highway 42 SumrallMS
CH04577ADActiveBPS-H80-035217SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Lamar County School Clinic424 Martin Luther King Dr PurvisMS
CH04577AEActiveBPS-H80-035220SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Lumberton Elementary School16 ADA Bounds Lane LumbertonMS
CH04577AFActiveBPS-H80-035221SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Baxterville School1201 Bilbo Rd LumbertonMS
CH04577AGActiveBPS-H80-035226SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Oak Grove High School5198 Old Highway 11 HattiesburgMS
CH04577AHActiveBPS-H80-035215SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Purvis Lower Elementary School5976 US Highway 11 PurvisMS
CH04577AJActiveBPS-H80-035223SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Purvis Middle School213 School St PurvisMS
CH04577AKActiveBPS-H80-035508SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Purvis Upper Elementary School310 Mitchell Ave PurvisMS
CH04577ALActiveBPS-H80-035225SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Oak Grove Elementary70 Leaf Ln HattiesburgMS
CH04577AMActiveBPS-H80-035219SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Purvis High School220 School St PurvisMS
CH04577ANActiveBPS-H80-035216SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Lumberton High School7920 U S Highway 11 LumbertonMS
CH04577APActiveBPS-H80-035509SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Oak Grove Middle School2543 Old Highway 24 HattiesburgMS
CH04577AQActiveBPS-H80-035506SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Oak Grove Longleaf5279 W 4th St HattiesburgMS
CH04577ARActiveBPS-H80-035224SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Bellevue Elementary1760 Old Highway 24 HattiesburgMS
CH04577BActiveBPS-H80-003486SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.SEMINARY FAMILY HEALTH CENTER100 HIGHWAY 535 SEMINARYMS
CH04577CActiveBPS-H80-004056SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.NEW AUGUSTA FAMILY HEALTH CENTER404 MAIN STREET NEW AUGUSTAMS
CH04577DActiveBPS-H80-002839SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.BROOKLYN FAMILY HEALTH CTR44 BROOKLYN-JANICE ROAD BROOKLYNMS
CH04577EActiveBPS-H80-000781SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.BEAUMONT FAMILY HEALTH CENTER1411 BRADLEY AVENUE BEAUMONTMS
CH04577FActiveBPS-H80-005128SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.LUMBERTON FAMILY HEALTH CENTER598 WEST 11TH AVENUE LUMBERTONMS
CH04577GActiveBPS-H80-003976SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.HATTIESBURG FAMILY HEALTH CENTER66 Old AIRPORT ROAD HATTIESBURGMS
CH04577MActiveBPS-H80-004360SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.WOMEN'S HEALTH CENTER62 OLD AIRPORT ROAD HATTIESBURGMS
CH04577NActiveBPS-H80-001157SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.HATTIESBURG PUBLIC SCHOOL AND COMMUNITY CLINIC404 LILLIE BURNEY STREET HATTIESBURGMS
CH04577PActiveBPS-H80-003301Southeast Mississippi Rural Health Initiative, Inc.Picayune Family Health Center1911 Read Rd PicayuneMS
CH04577QActiveBPS-H80-013968SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Petal School Clinic36 PANTHER STADIUM DR PETALMS
CH04577RActiveBPS-H80-005122SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.HATTIESBURG High School & COMMUNITY CLIN.605 Stadium Dr HattiesburgMS
CH04577SActiveBPS-H80-021856SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Minor Care Clinic123 S 27th Ave HattiesburgMS
CH04577TActiveBPS-H80-005970SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.HATTIESBURG HIGH SCHOOL CAMPUS CLINIC301 Hutchinson Ave HattiesburgMS
CH04577UActiveBPS-H80-000754SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.HATTIESBURG COMMUNITY DENTAL CTR68 Airport Rd HattiesburgMS
CH04577VActiveBPS-H80-014208SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.N.R. Burger School and Community Clinic180 WSF TATUM DRIVE EXT HATTIESBURGMS
CH04577WActiveBPS-H80-017936SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.SeMRHI Support Services Center64 Old Airport Road HattiesburgMS
CH04577XTerminatedBPS-H80-019214SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.Collins High School1208 S Dogwood Ave CollinsMS
CH04577YActiveBPS-H80-007297SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.GRACE CHRISTIAN ELEM SCHOOL2207 W 7th St HattiesburgMS
CH04577ZActiveBPS-H80-037574SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.SeMRHI Mobile Unit72 Old Airport Rd HattiesburgMS
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH04577030A INNOVATIONS,LLCFREEDOM PHARMACY 3902 HARDY STREET
HATTIESBURGMS3940201/01/2021  
CH045770ABITACARE LLCD/B/A VITAL CARE RX 1501 23RD AVE
SUITE B
MERIDIANMS3930107/01/2019  
CH045770AHSSHCEXPEDIEN RX PHARMACY 5050 WESLEY RD STE 120
APOPKAFL3271210/01/2018  
CH045770AVITA PHARMACY 1028340B PARTNERS PHARMACY-DALLAS LLC DBA AV 750 FORT WORTH AVE STE H100
DALLASTX75208-181107/01/2013  
CH045770AVITA PHARMACY 1037AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC 2519 CANAL ST
NEW ORLEANSLA7011901/01/2013  
CH045770AVITA PHARMACY 1040AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 6100 CORPORATE BLVD STE 250
BATON ROUGELA7080807/01/2013  
CH045770C&C DRUGS, INCC&C DRUGS, INC 204 MAIN ST
PO BOX 327
COLLINSMS3942810/01/2014  
CH045770CALEB'S HOMETOWN PHARMACY801 MAIN ST
COLLINSMS3942804/01/2016  
CH045770CENTERWELL PHARMACY, INC.9843 WINDISCH RD
WEST CHESTEROH4506904/01/2025  
CH045770CENTERWELL PHARMACY, INC.11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDOFL3282404/01/2025  
CH045770CITY REXALL DRUGS349 S MAIN ST
PICAYUNEMS39466-441504/01/2025  
CH045770FAIRVIEW DISCOUNT PHARMACY500 KATIE AVENUE
HATTIESBURGMS3940107/01/2017 07/02/2018
CH045770JOHN'S DISCOUNT DRUGS410 W MAIN AVE
LUMBERTONMS39455-243710/01/2017  
CH045770K & B MISSISSIPPI CORPORATIONRITE AID #7219 5916 US HIGHWAY 49
HATTIESBURGMS3940109/06/2012 01/16/2018
CH045770K & B MISSISSIPPI CORPORATIONRITE AID #7221 100 HIGHWAY 42
PETALMS3946509/06/2012 01/16/2018
CH045770LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05473 2103 GAUSE BLVD E
SLIDELLLA7046110/01/2019  
CH045770LOUISIANA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05330 1305 GAUSE BLVD.
SLIDELLLA7045810/01/2019  
CH045770LOUISIANA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 7192 800 BROWNSWITCH RD.
SLIDELLLA7045810/01/2019  
CH045770M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312610/01/2018  
CH045770MEDICAL CENTER PHARMACY141 KIRKWOOD ST
PICAYUNEMS39466-394604/01/2011  
CH04577PMEDICAL CENTER PHARMACY141 KIRKWOOD ST
PICAYUNEMS39466-394611/15/2010  
CH045770MISSISSIPPI CVS PHARMACY, L.L.C.CVS PHARMACY # 17144 6143 U S HIGHWAY 98 STE 80
HATTIESBURGMS3940210/01/2019  
CH045770MISSISSIPPI CVS PHARMACY, L.L.C.CVS/PHARMACY #8993 365 COLE ROAD
HATTIESBURGMS3940210/01/2019  
CH045770MISSISSIPPI CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05777 501 NORTH 16TH AVE.
LAURELMS3944010/01/2019  
CH045770MISSISSIPPI CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05744 3910 HARDY ST
HATTIESBURGMS3940210/01/2019  
CH045770MISSISSIPPI CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05740 1701 A HWY 43 N
PICAYUNEMS3946610/01/2019  
CH045770MISSISSIPPI CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 3124 2507 HARDY ST.
HATTIESBURGMS3940110/01/2019  
CH045770PEARL RIVER DRUG COMPANY510 S MAIN ST
POPLARVILLEMS3947004/01/2011 07/13/2015
CH04577FPEARL RIVER DRUG COMPANY510 S MAIN ST
POPLARVILLEMS3947011/15/2010 07/13/2015
CH045770PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310110/01/2018  
CH045770POMANK VENTURESDBA FAIRVIEW PHARMACY AND COMPOUNDING 500 KATIE AVE
HATTIESBURGMS3940107/10/2018  
CH045770SEMINARY DRUGSTAYLORSVILLE DRUGS, DBA 300 PINE STREET
PO BOX 1397
TAYLORSVILLEMS3916804/01/2015  
CH045770STRICKLAND'S CASH & SAVEDISCOUNT PHARMACY INC 703 N FRONT ST
PO BOX 1619
RICHTONMS3947607/26/2012  
CH045770SUMRALL DRUG STORE1109 MS HWY 42
SUMRALLMS3948204/01/2011  
CH04577ASUMRALL DRUG STORE1109 MS HWY 42
SUMRALLMS3948212/06/2010  
CH045770VITAL CARE OF MERIDIAN1501 23RD AVE
MERIDIANMS3930110/01/2016  
CH045770WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2019  
CH045770WAL-MART PHARMACY 10-088736 BYRD BLVD
PETALMS3946501/01/2019  
CH045770WAL-MART PHARMACY 10-09166072 U.S. HWY. 98
HATTIESBURGMS3940201/01/2019  
CH045770WAL-MART PHARMACY 10-0970235 FRONTAGE RD
PICAYUNEMS3946601/01/2019  
CH045770WAL-MART PHARMACY 10-11681001 HWY 98 BYPASS
COLUMBIAMS3942901/01/2019  
CH045770WAL-MART PHARMACY 10-27175901 HWY. 49 SOUTH
HATTIESBURGMS3940101/01/2019  
CH045770WAL-MART PHARMACY 10-35281053 FRONTAGE DRIVE EAST
WIGGINSMS3957701/01/2019  
CH045770WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/01/2019  
CH045770WALGREEN CODBA: WALGREENS #12929 804 SPRING STREET
WAYNESBOROMS3936710/01/2013  
CH045770WALGREEN CODBA: WALGREENS #10805 1628 SIMPSON HWY 49
MAGEEMS39111-500007/01/2017  
CH045770WALGREEN CO.DBA: WALGREENS # 05307 6130 U.S. HIGHWAY 49
HATTIESBURGMS3940110/01/2013  
CH045770WALGREEN CO.DBA: WALGREENS # 07579 5093 HARDY STREET
HATTIESBURGMS39402-133610/01/2013  
CH045770WALGREEN CO.DBA: WALGREENS # 10273 2209 HIGHWAY 11 NORTH
PICAYUNEMS39466-206510/01/2013  
CH045770WALGREEN CO.DBA: WALGREENS # 10290 1505 HIGHWAY 43 S
PICAYUNEMS39466-929710/01/2013  
CH045770WALGREEN CO.DBA: WALGREENS # 10430 103 WEST CENTRAL AVE
PETALMS39465-231310/01/2013  
CH045770WALGREEN CO.DBA: WALGREENS #13609 1028 HIGHWAY 98 BYPASS
COLUMBIAMS3942910/01/2013  
CH045770WALGREEN CO.DBA: WALGREENS # 09037 419 N 16TH AVE
LAURELMS39440-385007/01/2017  
CH045770WALGREEN CO.RITE AID #07221 100 HWY 42
PETALMS3946504/04/2018 03/28/2018
CH045770WALGREEN CO.ELLISVILLE DRUG #15828, POWERED BY WALGR 915 HILL STREET
ELLISVILLEMS3943707/01/2019  
CH045770WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21286 4500 OLD PASS RD
GULFPORTMS3950107/01/2023  
CH045770Walgreens #21389Walgreens Central Fill #21389 3299 Tchulatech Dr
Suite 101
MemphisTN3811807/01/2025  
CH045770WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528410/01/2013 06/25/2015
CH045770WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275604/01/2023  
CH045770Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH045770WINN DIXIE PHARMACY #13342800 LINCOLN ROAD
HATTIESBURGMS3940201/01/2019 09/04/2020
CH045770WINN DIXIE PHARMACY#26264400 HARDY ST
HATTIESBURGMS39402-137212/16/2020 11/01/2023
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/6/2024 9:49:32 AM2/14/2025 3:58:42 PM2/14/2025 3:58 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestEUBANKS, POLLY CFO Southeast Mississippi Rural Health Initiative, Inc. 6015458700Robinson, Janice CEO SeMRHI 60154537008/1/2024 11:37 AM
DetailsLast Recertification DateUpdateRecertification 2/6/2024 9:49:32 AM2/6/2024 9:49 AM
DetailsStateUpdate ApprovedActive1/1/2024 12:01 AM
ContactsSigned ByInsertNew Registration EUBANKS, POLLY CFO Southeast Mississippi Rural Health Initiative, Inc. 601545870010/20/2023 8:19 AM
Details340B IDUpdateNew Registration CH04577AQ10/20/2023 8:19 AM
DatesParticipating Approval DateUpdateNew Registration 10/20/2023 8:19:42 AM10/20/2023 8:19 AM
DetailsStateUpdateNew RegistrationPendingApproved10/20/2023 8:19 AM
DatesSigned By DateUpdateNew Registration 10/13/2023 12:17:54 AM10/20/2023 8:19 AM
DatesStart DateUpdateNew Registration 1/1/2024 12:00:00 AM10/20/2023 8:19 AM
AddressesMain AddressInsertNew Registration  5279 W 4th St Hattiesburg, MS 39402-970010/11/2023 11:55 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/11/2023 11:55 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 20000217510/11/2023 11:55 AM
Medicaid BillingMedicaid: StateInsertNew Registration MS10/11/2023 11:55 AM
Medicaid BillingNPI: NumberInsertNew Registration 105398522610/11/2023 11:55 AM
Medicaid BillingNPI: StateInsertNew Registration MS10/11/2023 11:55 AM
ContactsAuthorizing OfficialInsertNew Registration EUBANKS, POLLY CFO Southeast Mississippi Rural Health Initiative, Inc. 601545870010/11/2023 11:55 AM
ContactsPrimary ContactInsertNew Registration Ingram, Charnay Director of Pharmacy, PharmD Southeast Mississippi Rural Health Initiative, Inc. 6015444163-390210/11/2023 11:55 AM
DetailsAssistance Received From DateInsertNew Registration  10/11/2023 11:55 AM
DetailsAssistance Received To DateInsertNew Registration  10/11/2023 11:55 AM
DetailsLast Recertification DateInsertNew Registration  10/11/2023 11:55 AM
DetailsGrant NumberInsertNew Registration H80CS0061010/11/2023 11:55 AM
Details340B IDInsertNew Registration  10/11/2023 11:55 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/11/2023 11:55 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/11/2023 11:55 AM
DetailsMedicare Provider NumberInsertNew Registration  10/11/2023 11:55 AM
DetailsEntity NameInsertNew Registration SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.10/11/2023 11:55 AM
DetailsNOFO NumberInsertNew Registration  10/11/2023 11:55 AM
DetailsProgram CodeInsertNew Registration CH10/11/2023 11:55 AM
DetailsEntity SubnameInsertNew Registration Oak Grove Longleaf10/11/2023 11:55 AM
DatesParticipating Approval DateInsertNew Registration  10/11/2023 11:55 AM
DetailsStateInsertNew Registration Pending10/11/2023 11:55 AM
DatesRegistration DateInsertNew Registration 10/11/2023 11:55:43 AM10/11/2023 11:55 AM
DatesSigned By DateInsertNew Registration  10/11/2023 11:55 AM
DatesStart DateInsertNew Registration  10/11/2023 11:55 AM
TerminationsTermination CommentsInsertNew Registration  10/11/2023 11:55 AM
TerminationsTermination DateInsertNew Registration  10/11/2023 11:55 AM
TerminationsTermination Effective DateInsertNew Registration  10/11/2023 11:55 AM
TerminationsTermination ReasonInsertNew Registration  10/11/2023 11:55 AM