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CH04798B ARENIA C. MALLORY COMM HLTH CTR (Active)
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Main Details
Name
ARENIA C. MALLORY COMM HLTH CTR
Subdivision Name
Mallory CHC - Women's and Family Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-012493
340B ID
CH04798B
Grant Number
H80CS00580
Additional Details
Current Program Status
Active
Registration Date
8/31/2015
Participating Start Date
10/1/2015
Participating Approval Date
9/1/2015
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Mallory Community Health Center
Clyde Rozell Chapman, CEO
(662) 834-2566 Ext: 1013
Primary Contact
Mallory Community Health Center
Sammie Binder, Risk and Safety Officer
(662) 834-1857 Ext: 1030
Addresses
Street Address
276 Nissan Parkway BLDG C
Canton, MS 39046
Billing Address
DR. ARENIA C. MALLORY CHC, INC.
PO BOX 479
LEXINGTON, MS 39095
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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9/24/15 Participating from 7/1/04 until terminated 4/1/14, reinstated effective 10/1/15
09/24/2015
11/22/05 - REMOVED SHIP TO, REPLACED WITH CP
11/22/2005
May 2025
May 2025
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