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CH042377A NORTHEAST FLORIDA HEALTH SERVICES, INC. (Terminated)
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Main Details
Name
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Subdivision Name
DBA DELAND Family Health Source
Type
HRSA-Funded Health Center
Site ID
BPS-H80-000059
340B ID
CH042377A
Grant Number
H80CS02520
Additional Details
Current Program Status
Terminated
Registration Date
5/20/2008
Participating Start Date
7/1/2008
Participating Approval Date
5/22/2008
Last Recertification Date
2/3/2020
Termination Date
Termination Reason
4/1/2021
Site closure
Contacts
Authorizing Official
Northeast Florida Health Services, inc,
Laurie Asbury, CEO
(386) 624-1054
Primary Contact
Family Health Source
Hipolito Valdez, CFO
(386) 414-9601
Addresses
Street Address
844 W.PLYMOUTH AVENUE
DELAND, FL 32720-3284
Billing Address
NORTHEAST FLORIDA HEALTH SERVICES, INC.
1205 S Woodland BLVD
Deland, FL 32720
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
April 2025
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