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CH06192B DAVID RAINES COMMUNITY HEALTH CENTER, INC. (Active)
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Main Details
Name
DAVID RAINES COMMUNITY HEALTH CENTER, INC.
Subdivision Name
DAVID RAINES COMMUNITY HEALTH CENTER, INC - Gilliam
Type
HRSA-Funded Health Center
Site ID
BPS-H80-005056
340B ID
CH06192B
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
12763 LAY STREET
GILLIAM, LA 71029
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
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11/8/04 UPDATED ENTITY NAME; 11/8/04 ADDED BILL TO; 11/8/04 ADDED SHIP TO; 7/20/07 ADDED MEDICAID #
01/14/2010
April 2025
April 2025
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