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CH041260 ERLANGER HEALTH SYSTEM SOUTHSIDE/DODSON AVE CHC (Active)
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Main Details
Name
ERLANGER HEALTH SYSTEM SOUTHSIDE/DODSON AVE CHC
Subdivision Name
SOUTHSIDE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-005465
340B ID
CH041260
Grant Number
H80CS00091
Additional Details
Current Program Status
Active
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
1/21/2010
Last Recertification Date
2/19/2025
Contacts
Authorizing Official
Erlanger Health
Misty Brackett, VP Revenue Cycle
(423) 778-9775
Primary Contact
Erlanger SSDA Health Centers
Angel Moore, APDA
(423) 778-2805
Addresses
Street Address
3800 Tennessee Ave.
Suite 124
CHATTANOOGA, TN 37409
Billing Address
Southside Community Health Center
1200 Dodson Avenue
Chattanooga, TN 37406
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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12/21/05 UPDATED ENTITY NAME
01/21/2010
April 2025
April 2025
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