Covered Entity Details

CH06192T DAVID RAINES COMMUNITY HEALTH CENTER INC (Approved) - information as of 4/29/2025 11:59:31 PM

Main Details

Name

DAVID RAINES COMMUNITY HEALTH CENTER INC

Subdivision Name

David Raines CHC School Based Health Center-Broadmoor Stem Academy

Type

HRSA-Funded Health Center

Site ID

BPS-H80-038974

340B ID

CH06192T

Grant Number

H80CS00720

Additional Details

Current Program Status

Approved

Registration Date

4/2/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/8/2025

Last Recertification Date

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

441 Atlantic Ave
Shreveport, LA 71105-2911

Billing Address

David Raines Community Health Center
3041 Dr Martin Luther King Dr
Shreveport, LA 71107-4705

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
LA	2678973	1144079872

Shipping Addresses

Shipping Address 1

David Raines Community Health Center, Inc.
1625 David Raines Road
Shreveport, LA 71107-5899

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
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
Contacts	Signed By	Insert	New Registration		White III, Willie C. CEO David Raines Community Health Centers 3182273349-3160	4/8/2025 8:51 AM
Details	340B ID	Update	New Registration		CH06192T	4/8/2025 8:51 AM
Dates	Participating Approval Date	Update	New Registration		4/8/2025 8:51:05 AM	4/8/2025 8:51 AM
Details	State	Update	New Registration	Pending	Approved	4/8/2025 8:51 AM
Dates	Signed By Date	Update	New Registration		4/7/2025 9:20:24 AM	4/8/2025 8:51 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/8/2025 8:51 AM
Addresses	Main Address	Insert	New Registration		441 Atlantic Ave Shreveport, LA 71105-2911	4/2/2025 1:48 PM
Addresses	Billing Address	Insert	New Registration		David Raines Community Health Center 3041 Dr Martin Luther King Dr Shreveport, LA 71107-4705	4/2/2025 1:48 PM
Addresses	Shipping Address	Insert	New Registration		David Raines Community Health Center, Inc. 1625 David Raines Road Shreveport, LA 71107-5899	4/2/2025 1:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/2/2025 1:48 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		2678973	4/2/2025 1:48 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		LA	4/2/2025 1:48 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1144079872	4/2/2025 1:48 PM
Medicaid Billing	NPI: State	Insert	New Registration		LA	4/2/2025 1:48 PM
Contacts	Authorizing Official	Insert	New Registration		White III, Willie C. CEO David Raines Community Health Centers 3182273349-3160	4/2/2025 1:48 PM
Contacts	Primary Contact	Insert	New Registration		Edwards, Myrtis COO David Raines Community Health Centers 3182273342	4/2/2025 1:48 PM
Details	Assistance Received From Date	Insert	New Registration			4/2/2025 1:48 PM
Details	Assistance Received To Date	Insert	New Registration			4/2/2025 1:48 PM
Details	Last Recertification Date	Insert	New Registration			4/2/2025 1:48 PM
Details	Grant Number	Insert	New Registration		H80CS00720	4/2/2025 1:48 PM
Details	340B ID	Insert	New Registration			4/2/2025 1:48 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2025 1:48 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2025 1:48 PM
Details	Medicare Provider Number	Insert	New Registration			4/2/2025 1:48 PM
Details	Entity Name	Insert	New Registration		DAVID RAINES COMMUNITY HEALTH CENTER INC	4/2/2025 1:48 PM
Details	NOFO Number	Insert	New Registration			4/2/2025 1:48 PM
Details	Program Code	Insert	New Registration		CH	4/2/2025 1:48 PM
Details	Entity Subname	Insert	New Registration		David Raines CHC School Based Health Center-Broadmoor Stem Academy	4/2/2025 1:48 PM
Dates	Participating Approval Date	Insert	New Registration			4/2/2025 1:48 PM
Details	State	Insert	New Registration		Pending	4/2/2025 1:48 PM
Dates	Registration Date	Insert	New Registration		4/2/2025 1:48:12 PM	4/2/2025 1:48 PM
Dates	Signed By Date	Insert	New Registration			4/2/2025 1:48 PM
Dates	Start Date	Insert	New Registration			4/2/2025 1:48 PM
Terminations	Termination Comments	Insert	New Registration			4/2/2025 1:48 PM
Terminations	Termination Date	Insert	New Registration			4/2/2025 1:48 PM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2025 1:48 PM
Terminations	Termination Reason	Insert	New Registration			4/2/2025 1:48 PM

340B Drug Pricing Program Database