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CH04168AA FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC. (Terminated)
Main Details
Name
FAMILY HEALTH CENTERS OF SOUTHWEST FLORIDA, INC.
Subdivision Name
The Heights Medical Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-015246
340B ID
CH04168AA
Grant Number
H80CS00185
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
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/14/2015
Last Recertification Date
2/13/2017
Termination Date
4/1/2017
Termination Reason
Site closure
Addresses
Street Address
15570 Hagie Drive
Fort Myers, FL 33908
Billing Address
Family Health Centers of SW Florida, Inc
PO 1357
Fort Myers, FL 33902
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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