Covered Entity Details

CH04075AF CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INC (Active) - information as of 6/12/2025 6:04:28 AM

Main Details

Name

CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INC

Subdivision Name

Jackson-Hinds Medical Mobile Unit 6

Type

HRSA-Funded Health Center

Site ID

BPS-H80-036280

340B ID

CH04075AF

Grant Number

H80CS00084

Additional Details

Current Program Status

Active

Registration Date

1/9/2024

Participating Start Date

4/1/2024

Participating Approval Date

1/10/2024

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Central Mississippi Civic Improvement Association, Inc.
Jasmin Chapman, Chief Executive Officer
(601) 364-5142

Primary Contact

Central Mississippi Civic Improvement Association, Inc.
Techandra J Mayes, Chief Financial Officer
(601) 364-5182

Addresses

Street Address

3502 W Northside Dr
Jackson, MS 39213-4454

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	00330664	1548342611

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.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH040750	Active	BPS-H80-001074	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	CENTRAL MS CIVIC IMPROVEMENT ASSOC., INC.D/B/A JACKSON-HINDS COMPREHENSIVE HEATLH CENTER MAIN SITE	3502 W Northside Dr	Jackson	MS
CH04075A	Active	BPS-H80-008110	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Copiah Comprehensive Health Complex	550 Caldwell Dr	Hazlehurst	MS
CH04075AA	Active	BPS-H80-027100	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Raymond High School	14050 Highway 18	Raymond	MS
CH04075AB	Active	BPS-H80-027093	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Carver Middle School	560 Port Gibson St	Raymond	MS
CH04075AC	Active	BPS-H80-027094	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Raymond Elementary School	417 Palestine St	Raymond	MS
CH04075AD	Active	BPS-H80-032930	Central Mississippi Civic Improvement Association, Inc.	Jackson-Hinds Medical Mobile Unit 4	3502 W Northside Dr	Jackson	MS
CH04075AE	Active	BPS-H80-035624	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INC	Jackson-Hinds Medical Mobile Unit 5	3502 W Northside Dr	Jackson	MS
CH04075AF	Active	BPS-H80-036280	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INC	Jackson-Hinds Medical Mobile Unit 6	3502 W Northside Dr	Jackson	MS
CH04075AG	Active	BPS-H80-038072	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INC	Jackson-Hinds CHC - The Pearl	2649 Highway 80 W	Jackson	MS
CH04075AH	Active	BPS-H80-037891	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INC	Jackson-Hinds Blackburn Middle School	1311 W Pearl St	Jackson	MS
CH04075AJ	Active	BPS-H80-037890	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INC	Jackson-Hinds Cardoza Middle School	3180 McDowell Rd	Jackson	MS
CH04075B	Active	BPS-H80-009264	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Jackson-Hinds Utica Clinic	129 White Oak St	Utica	MS
CH04075C	Active	BPS-H80-032745	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	JACKSON-HINDS VICKSBURG WARREN FAMILY HEALTH CARE CLINIC	2524 S. Frontage Road I-20	Vicksburg	MS
CH04075D	Active	BPS-H80-006785	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	JACKSON-HINDS TOUGALOO CLINIC	500 W County Line Rd	Tougaloo	MS
CH04075E	Active	BPS-H80-004302	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	JACKSON-HINDS ETHEL JAMES IVORY HOMELESS CLINIC	327 S. Gallatin Street	Jackson	MS
CH04075F	Active	BPS-H80-008900	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Jackson-Hinds Comprehensive Health Center South Clinic	145 Raymond Rd	Jackson	MS
CH04075G	Active	BPS-H80-012408	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Jackson-HInds Comprehensive Health Center Edwards Site	100 South Magnolia	Edwards	MS
CH04075H	Terminated	BPS-H80-019519	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Jackson-Hinds Central Mississippi Medical Center Site	1860 Chadwick Dr STE 254	Jackson	MS
CH04075J	Active	BPS-H80-009605	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Jackson-Hinds Comprehensive Health Center at the Jackson Medical Mall	350 W Woodrow Wilson Ave	Jackson	MS
CH04075K	Active	BPS-H80-012405	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Jackson-Hinds Comprehensive Health Center Woodrow Wilson Clinic	514 A-B East Woodrow Wilson	Jackson	MS
CH04075L	Terminated	BPS-H80-015738	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Commonwealth Apartment Complex	3930 SKYVIEW DR	JACKSON	MS
CH04075M	Terminated	BPS-H80-015744	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	The Village Apartment Complex	386 RAYMOND RD	JACKSON	MS
CH04075N	Active	BPS-H80-005701	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	JACKSON-HINDS JIM HILL HIGH SCHOOL SBHC	2185 Fortune St	Jackson	MS
CH04075P	Active	BPS-H80-005948	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	JACKSON-HINDS VAN WINKLE ELEM SCHOOLBASE CLINIC	1655 Whiting Rd	Jackson	MS
CH04075Q	Active	BPS-H80-006284	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	JACKSON-HINDS-ISABLE ELEMENTARY SCHOOL SBHC	1716 Isable St	Jackson	MS
CH04075R	Active	BPS-H80-006983	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	UTICA ELEMENTARY SCHOOL	260 HIGHWAY 18 AND 27	UTICA	MS
CH04075S	Active	BPS-H80-006598	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	BOLTON-EDWARDS ELEM/MIDDLE SBC	9700 I-20 WEST FRONTAGE RD	BOLTON	MS
CH04075T	Active	BPS-H80-014170	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Byram Middle School-based Clinic	2009 BYRAM BULLDOG BLVD	TERRY	MS
CH04075U	Active	BPS-H80-015713	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Pecan Park Elementary School-Based Clinic	415 CLAIBORNE AVE	JACKSON	MS
CH04075V	Active	BPS-H80-014171	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Terry High School-based Clinic	235 W BEASLEY ST	TERRY	MS
CH04075W	Active	BPS-H80-005877	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Jackson-Hinds Medical/Dental Mobile Unit 2	3502 W Northside Dr	Jackson	MS
CH04075X	Active	BPS-H80-015198	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Jackson-Hinds Medical Mobile Unit 3	3502 West Northside Drive	JACKSON	MS
CH04075Y	Active	BPS-H80-019309	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Gary Road Elementary School	7241 Gary Road	Byram	MS
CH04075Z	Active	BPS-H80-019310	CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION, INC.	Gary Road Intermediate School	7255 Gary Road	Byram	MS

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH04075D	KROGER CO	DBA KROGER FOOD AND DRUG	#V-357 2000 E COUNTY LINE ROAD	RIDGELAND	MS	39157	03/23/2011
CH04075B	KROGER PHARMACY #466	3408 PEMBERTON SQUARE BLVD		VICKSBURG	MS	39180-5573	04/07/2011
CH040750	SUPER D DRUGS ACQUISITION CO.	DBA: WALGREENS #15742	4329 N. STATE STREET, SUITE #10	JACKSON	MS	39206	07/01/2015	07/27/2015
CH040750	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2024
CH040750	WAL-MART PHARMACY 10-0708	2150 IOWA AVENUE		VICKSBURG	MS	39180	10/01/2024
CH040750	WAL-MART PHARMACY 10-0875	815 S WHEATLEY RD		RIDGELAND	MS	39157	10/01/2024
CH040750	WAL-MART PHARMACY 10-0903	2711 GREENWAY DRIVE		JACKSON	MS	39204	10/01/2024
CH040750	WAL-MART PHARMACY 10-1710	950 HIGHWAY 80 EAST		CLINTON	MS	39056	10/01/2024
CH040750	WAL-MART PHARMACY 10-2720	127 GRAND VIEW BLVD		MADISON	MS	39110	10/01/2024
CH040750	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2024
CH040750	WAL-MART PHARMACY 10-954	527 LAKE STREET		HAZLEHURST	MS	39083	10/01/2024
CH040750	WALGREEN CO	DBA: WALGREENS #10694	5780 TERRY RD	BYRAM	MS	39272	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 04191	3445 TERRY ROAD	JACKSON	MS	39212	10/01/2013	03/02/2020
CH040750	WALGREEN CO.	DBA: WALGREENS #16089	310 MEADOWBROOK ROAD	JACKSON	MS	39206	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS #11111	1100 HWY 51	MADISON	MS	39110	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS #15485	1583 EAST COUNTY LINE ROAD	JACKSON	MS	39211	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 05165	204 HIGHWAY 80 EAST	CLINTON	MS	39056	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 05098	955 N STATE ST	JACKSON	MS	39202	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 05791	1497 CANTON MART RD	JACKSON	MS	39211	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 07517	977 ELLIS AVENUE	JACKSON	MS	39209-6256	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 07184	2896 MCDOWELL ROAD EXTENSION	JACKSON	MS	39204-4238	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 03918	3189 HWY 80 EAST	PEARL	MS	39208	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 09402	3341 HALLS FERRY RD	VICKSBURG	MS	39180-5338	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 07656	1199 HWY 49 SOUTH	RICHLAND	MS	39218-4425	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 09896	301 N DAVIS AVE	CLEVELAND	MS	38732-2349	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS #12154	28095 HWY 28	HAZLEHURST	MS	39083	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 10270	1000 HUGH WARD BLVD	FLOWOOD	MS	39232	10/01/2013
CH040750	WALGREEN CO.	DBA: WALGREENS # 05655	6970 OLD CANTON ROAD	RIDGELAND	MS	39157	04/01/2017
CH040750	WALGREEN CO.	DBA: WALGREENS #12822	1790 W GOVERNMENT STREET	BRANDON	MS	39042-2411	10/01/2017
CH040750	WALGREEN CO.	WALGREENS #19297	380 W WOODROW WILSON AVE	JACKSON	MS	39213	01/01/2019	11/14/2022
CH040750	WALGREEN CO.	WALGREENS #17030	2310 CLAY ST	VICKSBURG	MS	39183	04/01/2019
CH040750	WALGREEN CO.	WALGREENS #21165	971 LAKELAND DRIVE SUITE 101	JACKSON	MS	39216	04/01/2019
CH040750	WALGREEN CO.	DBA: WALGREENS # 01166	719 BROOKWAY BLVD	BROOKHAVEN	MS	39601-2639	01/01/2022
CH040750	WALGREEN CO.	DBA: WALGREENS # 10067	1005 W BEACON ST	PHILADELPHIA	MS	39350-3203	01/01/2022
CH040750	WALGREEN CO.	DBA: WALGREENS #12536	219 WOODLAND DRIVE NORTH	FOREST	MS	39074	01/01/2022
CH040750	WALGREEN CO.	DBA: WALGREENS #15250	1606 HIGHLAND COLONY PARKWAY	MADISON	MS	39110	01/01/2022
CH040750	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2013	07/27/2015
CH040750	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2024
CH040750	WALMART PHARMACY 10-6469	131 HANDLEY BLVD		BYRAM	MS	39272	10/01/2024
CH040750	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/12/2025 11:21:10 AM	2/12/2025 11:21 AM
Contacts	Authorizing Official	Update	Group Change Request	Chapman, Jasmin Chief Executive Officer Central Mississippi Civic Improvement Association, Inc. 6013645142	Chapman, Jasmin Chief Executive Officer Central Mississippi Civic Improvement Association, Inc. 6013645142	10/28/2024 12:23 PM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Chapman, Jasmin Chief Executive Officer Central Mississippi Civic Improvement Association, Inc. 6013645142	1/10/2024 7:48 AM
Details	340B ID	Update	New Registration		CH04075AF	1/10/2024 7:48 AM
Dates	Participating Approval Date	Update	New Registration		1/10/2024 7:48:47 AM	1/10/2024 7:48 AM
Details	State	Update	New Registration	Pending	Approved	1/10/2024 7:48 AM
Dates	Signed By Date	Update	New Registration		1/9/2024 10:15:40 AM	1/10/2024 7:48 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	1/10/2024 7:48 AM
Addresses	Main Address	Insert	New Registration		3502 W Northside Dr Jackson, MS 39213-4454	1/9/2024 10:15 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 10:15 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		00330664	1/9/2024 10:15 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MS	1/9/2024 10:15 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1548342611	1/9/2024 10:15 AM
Medicaid Billing	NPI: State	Insert	New Registration		MS	1/9/2024 10:15 AM
Contacts	Primary Contact	Insert	New Registration		Mayes, Techandra J Chief Financial Officer Central Mississippi Civic Improvement Association, Inc. 6013645182	1/9/2024 10:15 AM
Contacts	Authorizing Official	Insert	New Registration		Chapman, Jasmin Chief Executive Officer Central Mississippi Civic Improvement Association, Inc. 6013645142	1/9/2024 10:15 AM
Details	Assistance Received From Date	Insert	New Registration			1/9/2024 10:15 AM
Details	Assistance Received To Date	Insert	New Registration			1/9/2024 10:15 AM
Details	Last Recertification Date	Insert	New Registration			1/9/2024 10:15 AM
Details	Grant Number	Insert	New Registration		H80CS00084	1/9/2024 10:15 AM
Details	340B ID	Insert	New Registration			1/9/2024 10:15 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/9/2024 10:15 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/9/2024 10:15 AM
Details	Medicare Provider Number	Insert	New Registration			1/9/2024 10:15 AM
Details	Entity Name	Insert	New Registration		CENTRAL MISSISSIPPI CIVIC IMPROVEMENT ASSOCIATION INC	1/9/2024 10:15 AM
Details	NOFO Number	Insert	New Registration			1/9/2024 10:15 AM
Details	Program Code	Insert	New Registration		CH	1/9/2024 10:15 AM
Details	Entity Subname	Insert	New Registration		Jackson-Hinds Medical Mobile Unit 6	1/9/2024 10:15 AM
Dates	Participating Approval Date	Insert	New Registration			1/9/2024 10:15 AM
Details	State	Insert	New Registration		Pending	1/9/2024 10:15 AM
Dates	Registration Date	Insert	New Registration		1/9/2024 10:15:35 AM	1/9/2024 10:15 AM
Dates	Signed By Date	Insert	New Registration			1/9/2024 10:15 AM
Dates	Start Date	Insert	New Registration			1/9/2024 10:15 AM
Terminations	Termination Comments	Insert	New Registration			1/9/2024 10:15 AM
Terminations	Termination Date	Insert	New Registration			1/9/2024 10:15 AM
Terminations	Termination Effective Date	Insert	New Registration			1/9/2024 10:15 AM
Terminations	Termination Reason	Insert	New Registration			1/9/2024 10:15 AM

340B Drug Pricing Program Database