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CH047980 ARENIA C. MALLORY COMM HLTH CTR (Active)
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Main Details
Name
ARENIA C. MALLORY COMM HLTH CTR
Subdivision Name
DR ARENIA C. MALLORY CHC, INC.
Type
HRSA-Funded Health Center
Site ID
BPS-H80-005582
340B ID
CH047980
Grant Number
H80CS00580
Additional Details
Current Program Status
Active
Registration Date
8/31/2015
Participating Start Date
10/1/2015
Participating Approval Date
9/3/2015
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
17280 Highway 17
Lexington, MS 39095-6614
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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9/3/15 participating 07/01/2004 until terminated 4/1/15, reinstated effective 10/1/15
09/03/2015
8/3/15 Due to a reinstatement process gone awry, on 8/3/15 the records with CEID 22726 was updated in error with information from a registration with 340B ID CH04798E. The changes were reversed the same day so that CH047980 would continue to be a record in the database;
08/03/2015
April 2025
April 2025
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