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CH042377B NORTHEAST FLORIDA HEALTH SERVICES, INC. (Terminated)
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Main Details
Name
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Subdivision Name
DBA DELTONA MEDICAL CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-007644
340B ID
CH042377B
Grant Number
H80CS02520
Additional Details
Current Program Status
Terminated
Registration Date
11/6/2008
Participating Start Date
1/1/2009
Participating Approval Date
11/6/2008
Last Recertification Date
2/3/2021
Termination Date
Termination Reason
4/1/2022
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
2160 HOWLAND BLVD
DELTONA, FL 32718-3467
Billing Address
NORTHEAST FLORIDA HEALTH SERVICES, INC.
1205 S Woodland Blvd
3
Deland, FL 32720
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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