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CH04168Q FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC. (Active)
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Main Details
Name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Subdivision Name
BROADWAY DENTAL OFFICE
Type
HRSA-Funded Health Center
Site ID
BPS-H80-002503
340B ID
CH04168Q
Grant Number
H80CS00185
Additional Details
Current Program Status
Active
Registration Date
4/5/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/18/2019
Last Recertification Date
3/4/2025
Contacts
Authorizing Official
Family Health Centers of Southwest Florida, Inc.
Carrie Poulsom, VP & Chief Pharmacy Officer
(239) 344-2321
Primary Contact
Family Health Centers of SWFL Inc
Crystal Lancon, Pharmacy Compliance Administrator
(239) 344-2315
Addresses
Street Address
3600 BROADWAY AVE
FORT MYERS, FL 33901-8005
Billing Address
Family Health Centers of SW Florida, Inc
P.O. Box 1357
Fort Myers, FL 33902
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Participated starting 1/1/2013, terminated 4/1/2019. Reinstated 7/1/2019.
04/12/2019
11/1/12 - Record found, forwarded to IS for approval. 10/17/12 - Delete not in EHB.
11/01/2012
10/17/12 - Delete not in EHB.
10/17/2012
June 2025
June 2025
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