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CH04168V FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC. (Terminated)
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Main Details
Name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Subdivision Name
Renaissance Preserve Office
Type
HRSA-Funded Health Center
Site ID
BPS-H80-012521
340B ID
CH04168V
Grant Number
H80CS00185
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2014
Participating Start Date
7/1/2014
Participating Approval Date
4/18/2014
Last Recertification Date
2/13/2017
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Family Health Centers of Southwest Florida, Inc.
Frank Mazzeo Jr., CEO
(239) 278-3600
Primary Contact
Family Health Centers of SW Florida
Carrie Poulsom, VP & Chief Pharmacy Officer
(239) 344-2321
Addresses
Street Address
4211 Romeo Ln
Fort Myers, FL 33916-4810
Billing Address
Family Health Centers of SW Florida
Po Box 1357
Fort Myers, FL 33902
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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