Covered Entity Details

CH061920 DAVID RAINES COMMUNITY HEALTH CENTER, INC. (Active) - information as of 5/17/2025 10:45:50 PM

Main Details

Name

DAVID RAINES COMMUNITY HEALTH CENTER, INC.

Subdivision Name

DAVID RAINES COMMUNITY HEALTH CENTER, INC. - Shreveport

Type

HRSA-Funded Health Center

Site ID

BPS-H80-004265

340B ID

CH061920

Grant Number

H80CS00720

Additional Details

Current Program Status

Active

Registration Date

10/1/2003

Participating Start Date

10/1/2003

Participating Approval Date

11/8/2004

Last Recertification Date

2/14/2025

Contacts

Authorizing Official

David Raines Community Health Centers
Willie C. White III, CEO
(318) 227-3349 Ext: 3160

Primary Contact

David Raines Community Health Centers
Myrtis Edwards, COO
(318) 227-3342

Addresses

Street Address

1625 David Raines Rd
Shreveport, LA 71107-5899

Billing Address

David Raines Community Health Centers
3041 Dr. MLK Jr. Drive
Shreveport, LA 71107-7068

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
11/8/04 UPDATED ENTITY NAME; 7/20/07 ADDED MEDICAID #	01/14/2010

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
LA	1233358	1861415721

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	04/08/2016	07/01/2016		04/08/2016
Contract Detail	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	04/08/2016	07/01/2016		04/08/2016
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07004	2107 AIRLINE DRIVE	BOSSIER CITY	LA	71111-5801	01/14/2015	04/01/2015		01/14/2015
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09492	3100 N MARKET ST	SHREVEPORT	LA	71107-4005	01/14/2015	04/01/2015		01/14/2015
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05181	3555 GREENWOOD RD	SHREVEPORT	LA	71109	01/14/2015	04/01/2015		01/14/2015
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04998	9209 MANSFIELD RD.	SHREVEPORT	LA	71118	01/14/2015	04/01/2015		01/14/2015
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05992	3124 LINE AVE	SHREVEPORT	LA	71104	01/14/2015	04/01/2015		01/14/2015
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07595	6101 WEST 70TH STREET	SHREVEPORT	LA	71129-2507	01/14/2015	04/01/2015		01/14/2015
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05163	300 SOUTHFIELD RD	SHREVEPORT	LA	71105	01/14/2015	04/01/2015		01/14/2015
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09998	3400 AIRLINE DR	BOSSIER CITY	LA	71111	01/14/2015	04/01/2015		01/14/2015
Contract Detail	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15402	625 HOMER RD	MINDEN	LA	71055	01/14/2015	04/01/2015		01/14/2015
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/14/2015	04/01/2015	06/30/2015	07/13/2015
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	01/14/2015	04/01/2015	06/30/2015	07/13/2015
Contract Detail	Walgreens MFC #21373	4100 Dale Earnhardt Way	200	Northlake	TX	76262	10/16/2023	01/01/2024		01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH061920	Active	BPS-H80-004265	DAVID RAINES COMMUNITY HEALTH CENTER, INC.	DAVID RAINES COMMUNITY HEALTH CENTER, INC. - Shreveport	1625 David Raines Rd	Shreveport	LA
CH06192B	Active	BPS-H80-005056	DAVID RAINES COMMUNITY HEALTH CENTER, INC.	DAVID RAINES COMMUNITY HEALTH CENTER, INC - Gilliam	12763 LAY STREET	GILLIAM	LA
CH06192C	Active	BPS-H80-005274	DAVID RAINES COMMUNITY HEALTH CENTER, INC.	David Raines Community Health Center, Inc. - Minden	128 HOMER RD	MINDEN	LA
CH06192D	Active	BPS-H80-000831	DAVID RAINES COMMUNITY HEALTH CENTER, INC.	DAVID RAINES COMMUNITY HEALTH CENTER, INC. - HAYNESVILLE	1953 MAIN ST	HAYNESVILLE	LA
CH06192E	Active	BPS-H80-003901	DAVID RAINES COMMUNITY HEALTH CENTER, INC.	David Raines Community Health Centers, Inc. - Bossier	1514 Doctors Dr	Bossier City	LA
CH06192F	Active	BPS-H80-013240	DAVID RAINES COMMUNITY HEALTH CENTER, INC.	David Raines Community Health Center	3021 W 70th St	Shreveport	LA
CH06192G	Active	BPS-H80-020863	David Raines Community Health Center, Inc.	David Raines School Based Health Center - Woodlawn	7340 Wyngate Blvd.	Shreveport	LA
CH06192H	Active	BPS-H80-020896	David Raines Community Health Center, Inc.	David Raines School Based Health Center - JS Clark	351 Hearne Ave	Shreveport	LA
CH06192J	Active	BPS-H80-020835	David Raines Community Health Center, Inc.	David Raines School Based Health Center - Linwood	401 W. 70th Street	Shreveport	LA
CH06192K	Active	BPS-H80-020894	David Raines Community Health Center, Inc.	David Raines School Based Health Center - Atkins	7611 St. Vincent Ave	shreveport	LA
CH06192L	Active	BPS-H80-027852	David Raines Community Health Center, Inc.	David Raines School Based Health Center - OakPark	4331 Henry St	Shreveport	LA
CH06192M	Active	BPS-H80-032856	DAVID RAINES COMMUNITY HEALTH CENTER, INC.	David Raines Community Health Center - Walnut Hill	9360 Woolworth Rd Bldg	Shreveport	LA
CH06192N	Active	BPS-H80-035326	DAVID RAINES COMMUNITY HEALTH CENTER INC	David Raines School Based Health Center- Keithville Elementary/Middle	12201 Mansfield Rd	Keithville	LA
CH06192P	Active	BPS-H80-035325	DAVID RAINES COMMUNITY HEALTH CENTER INC	David Raines School Based Health Center - Fair Park Middle	3222 Greenwood Rd	Shreveport	LA
CH06192Q	Active	BPS-H80-037069	DAVID RAINES COMMUNITY HEALTH CENTER INC	David Raines Community School-Based Health Center- Turner	5904 W 70th St	Shreveport	LA
CH06192R	Approved	BPS-H80-039461	DAVID RAINES COMMUNITY HEALTH CENTER INC	David Raines Community School Based Health Center- Bossier High School	777 Bearkat Dr	Bossier City	LA
CH06192S	Approved	BPS-H80-039462	DAVID RAINES COMMUNITY HEALTH CENTER INC	David Raines Community School Based Health Center-Rusheon Middle School	2401 Old Minden Rd	Bossier City	LA
CH06192T	Approved	BPS-H80-038974	DAVID RAINES COMMUNITY HEALTH CENTER INC	David Raines CHC School Based Health Center-Broadmoor Stem Academy	441 Atlantic Ave	Shreveport	LA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH061920	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	07/01/2016
CH061920	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	07/01/2016
CH061920	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07004	2107 AIRLINE DRIVE	BOSSIER CITY	LA	71111-5801	04/01/2015
CH061920	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09492	3100 N MARKET ST	SHREVEPORT	LA	71107-4005	04/01/2015
CH061920	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05181	3555 GREENWOOD RD	SHREVEPORT	LA	71109	04/01/2015
CH061920	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 04998	9209 MANSFIELD RD.	SHREVEPORT	LA	71118	04/01/2015
CH061920	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05992	3124 LINE AVE	SHREVEPORT	LA	71104	04/01/2015
CH061920	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 07595	6101 WEST 70TH STREET	SHREVEPORT	LA	71129-2507	04/01/2015
CH061920	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 05163	300 SOUTHFIELD RD	SHREVEPORT	LA	71105	04/01/2015
CH061920	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS # 09998	3400 AIRLINE DR	BOSSIER CITY	LA	71111	04/01/2015
CH061920	WALGREEN LOUISIANA CO., INC.	DBA: WALGREENS #15402	625 HOMER RD	MINDEN	LA	71055	04/01/2015
CH061920	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2015	06/30/2015
CH061920	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/01/2015	06/30/2015
CH061920	Walgreens MFC #21373	4100 Dale Earnhardt Way	200	Northlake	TX	76262	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/19/2024 9:41:51 AM	2/14/2025 3:26:56 PM	2/14/2025 3:26 PM
Contacts	Primary Contact	Update	PC Change Request	Edwards, myrtis LaJuan Chief Operating Officer David Raines Community Health Centers 3182273341-3151	Edwards, Myrtis COO David Raines Community Health Centers 3182273342	2/20/2024 10:12 AM
Details	Last Recertification Date	Update	Recertification	2/24/2023 12:56:59 PM	2/19/2024 9:41:51 AM	2/19/2024 9:41 AM
Details	Last Recertification Date	Update	Recertification	1/31/2022 12:31:41 PM	2/24/2023 12:56:59 PM	2/24/2023 12:56 PM
Contacts	Authorizing Official	Update	AO Change Request	Hays, Rusty Allen Pharmacist David Raines Community Health Center 3188416057-2167	White III, Willie C. CEO David Raines Community Health Centers 3182273349-3160	2/24/2023 12:37 PM
Details	Last Recertification Date	Update	Recertification	2/24/2021 10:43:45 AM	1/31/2022 12:31:41 PM	1/31/2022 12:31 PM
Contacts	Authorizing Official	Update	AO Change Request	White III, Willie C. CEO David Raines Community Health Centers 3182273349-3160	Hays, Rusty Allen Pharmacist David Raines Community Health Center 3188416057-2167	1/28/2022 12:32 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1941638 (LA)		3/28/2021 3:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/28/2021 3:07 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1233358	3/28/2021 3:07 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	3/28/2021 3:07 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1215933254 (LA)		3/28/2021 3:07 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1861415721	3/28/2021 3:07 PM
Medicaid Billing	NPI: State	Insert	Change Request		LA	3/28/2021 3:07 PM
Contacts	Primary Contact	Update		Edwards, myrtis Chief Operating Officer David Raines Community Health Centers 3182273341-3151	Edwards, myrtis LaJuan Chief Operating Officer David Raines Community Health Centers 3182273341-3151	3/3/2021 4:32 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1233358 (LA)		2/24/2021 10:43 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/24/2021 10:43 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1941638	2/24/2021 10:43 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	2/24/2021 10:43 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1215933254	2/24/2021 10:43 AM
Medicaid Billing	NPI: State	Insert	Recertification		LA	2/24/2021 10:43 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1861415721 ( )		2/24/2021 10:43 AM
Details	Last Recertification Date	Update	Recertification	1/28/2020 2:10:26 PM	2/24/2021 10:43:45 AM	2/24/2021 10:43 AM
Details	Last Recertification Date	Update	Recertification	1/30/2019 9:21:56 AM	1/28/2020 2:10:26 PM	1/28/2020 2:10 PM
Details	Last Recertification Date	Update	Recertification	2/16/2018 12:14:22 PM	1/30/2019 9:21:56 AM	1/30/2019 9:21 AM
Contacts	Primary Contact	Update	Recertification	Edwards, myrtis Chief Operating Officer David Raines Community Health Centers 3182273342-3151	Edwards, myrtis Chief Operating Officer David Raines Community Health Centers 3182273341-3151	1/30/2019 9:17 AM
Addresses	Billing Address	Update	Change Request	DAVID RAINES COMMUNITY HEALTH CENTER, INC. PO BOX 7068 SHREVEPORT, LA 71137-7068	David Raines Community Health Centers 3041 Dr. MLK Jr. Drive Shreveport, LA 71107-7068	2/16/2018 12:17 PM
Contacts	Primary Contact	Update	Recertification	White III, Willie C. CEO David Raines Community Health Centers 3182273349-3160	Edwards, myrtis Chief Operating Officer David Raines Community Health Centers 3182273342-3151	2/16/2018 12:14 PM
Details	Last Recertification Date	Update	Recertification	2/9/2017 12:00:00 AM	2/16/2018 12:14:22 PM	2/16/2018 12:14 PM
Contacts	Authorizing Official	Update		White III, Willie C. CEO 3182273349-3160	White III, Willie C. CEO David Raines Community Health Centers 3182273349-3160	2/14/2018 11:24 AM
Contacts	Primary Contact	Update		White III, Willie C. CEO 3182273349-3160	White III, Willie C. CEO David Raines Community Health Centers 3182273349-3160	2/14/2018 11:24 AM
Addresses	Main Address	Insert			1625 David Raines Rd Shreveport, LA 71107-5899	2/9/2017 9:45 AM
Contacts	Authorizing Official	Update		WHITE III, WILLIE C. CEO 3182273355-12	White III, Willie C. CEO 3182273349-3160	2/9/2017 9:45 AM
Contacts	Primary Contact	Update		Murphy, Susie B. DIRECTOR OF PHARMACY 3188416057-2166	White III, Willie C. CEO 3182273349-3160	2/9/2017 9:45 AM
Details	Last Recertification Date	Update		2/26/2016 12:00:00 AM	2/9/2017 12:00:00 AM	2/9/2017 9:45 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	2/26/2016 2:38 PM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	2/26/2016 12:00:00 AM	2/26/2016 2:38 PM
Contacts	Primary Contact	Update		Murphy, Susie B. Pharmacy Director 3185492500-168	Murphy, Susie B. DIRECTOR OF PHARMACY 3188416057-2166	3/4/2015 8:44 AM
Details	Last Recertification Date	Update		3/13/2014 12:00:00 AM	3/4/2015 12:00:00 AM	3/4/2015 8:44 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/13/2014 12:00:00 AM	3/13/2014 11:57 AM
Details	Entity Subname	Update			DAVID RAINES COMMUNITY HEALTH CENTER, INC. - Shreveport	3/13/2014 11:57 AM
Contacts	Primary Contact	Update		BAIN, KENNY DIRECTOR OF PHARMACY 3184252252	Murphy, Susie B. Pharmacy Director 3185492500-168	3/15/2013 9:23 AM
Contacts	Authorizing Official	Insert			WHITE III, WILLIE C. CEO 3182273355-12	3/15/2013 9:23 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/15/2013 9:22 AM
Addresses	Billing Address	Insert			DAVID RAINES COMMUNITY HEALTH CENTER, INC. PO BOX 7068 SHREVEPORT, LA 71137-7068	12/5/2012 9:12 AM
Contacts	Primary Contact	Insert			BAIN, KENNY DIRECTOR OF PHARMACY 3184252252	1/14/2010 1:28 PM
Details	Last Recertification Date	Insert				1/14/2010 1:28 PM
Details	Grant Number	Insert			H80CS00720	1/14/2010 1:28 PM
Details	340B ID	Insert			CH061920	1/14/2010 1:28 PM
Details	Is Authorizing Official EHB Data	Insert				1/14/2010 1:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/14/2010 1:28 PM
Details	Medicare Provider Number	Insert				1/14/2010 1:28 PM
Details	Entity Name	Insert			DAVID RAINES COMMUNITY HEALTH CENTER, INC.	1/14/2010 1:28 PM
Details	Program Code	Insert			CH	1/14/2010 1:28 PM
Details	Entity Subname	Insert				1/14/2010 1:28 PM
Dates	Participating Approval Date	Insert			11/8/2004 12:00:00 AM	1/14/2010 1:28 PM
Details	State	Insert			Active	1/14/2010 1:28 PM
Dates	Registration Date	Insert			10/1/2003 12:00:00 AM	1/14/2010 1:28 PM
Dates	Signed By Date	Insert				1/14/2010 1:28 PM
Dates	Start Date	Insert			10/1/2003 12:00:00 AM	1/14/2010 1:28 PM
Terminations	Termination Comments	Insert				1/14/2010 1:28 PM
Terminations	Termination Date	Insert				1/14/2010 1:28 PM
Terminations	Termination Effective Date	Insert				1/14/2010 1:28 PM
Terminations	Termination Reason	Insert				1/14/2010 1:28 PM
Details	Comments Public	Insert			11/8/04 UPDATED ENTITY NAME; 7/20/07 ADDED MEDICAID #	1/14/2010 1:28 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	10/1/2003 12:00 AM
Medicaid Billing	Medicaid: Number	Insert			1233358	10/1/2003 12:00 AM
Medicaid Billing	Medicaid: State	Insert			LA	10/1/2003 12:00 AM
Medicaid Billing	NPI: Number	Insert			1861415721	10/1/2003 12:00 AM

340B Drug Pricing Program Database