Covered Entity Details

CHC00836-04 SOUTH CENTRAL PRIMARY CARE CENTER (Terminated)

Main Details

Name

SOUTH CENTRAL PRIMARY CARE CENTER

Subdivision Name

Kid's Health

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013002

340B ID

CHC00836-04

Grant Number

H80CS00836

Additional Details

Current Program Status

Terminated

Registration Date

7/9/2013

Participating Start Date

7/1/2014

Participating Approval Date

9/15/2013

Last Recertification Date

1/29/2024

Termination Date
Termination Reason

10/1/2024
Site closure

Contacts

Authorizing Official

South Central Primary Care Center, Inc.
Robert B. Tucker, CEO
(229) 468-9166 Ext: 1

Primary Contact

South Central Primary Care Center, Inc.
Judy Swanson, Nurse Manager
(229) 468-9166

Addresses

Street Address

119 Norman Dorminy Drive, Suite A
Fitzgerald, GA 31750-8855

Billing Address
Same as Street Address

Comment	Last Updated On
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5/2/14 participating 10/1/13 thru 3/31/14, not participating 4/1/14 thru 6/30/14, re-instated based on new registration submitted in April 2014, site was not really removed from the scope of project but EHB site record was terminated due to a problem with the address and a new record was created with a different site ID; 3/18/14 site was removed from the scope of project of the H80 grant effective 11/14/13	05/02/2014
3/18/14 site was removed from the scope of project of the H80 grant effective 11/14/13	03/18/2014

340B Drug Pricing Program Database