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CH04168H FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC. (Active)
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Main Details
Name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Subdivision Name
Port Charlotte Pediatric & Dental Office
Type
HRSA-Funded Health Center
Site ID
BPS-H80-012532
340B ID
CH04168H
Grant Number
H80CS00185
Additional Details
Current Program Status
Active
Registration Date
10/9/2012
Participating Start Date
1/1/2013
Participating Approval Date
11/1/2012
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
4300 Kings Hwy STE 500
Port Charlotte, FL 33980-2953
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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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
May 2025
May 2025
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