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CH04170D COLLIER HEALTH SERVICES, INC. (Terminated)
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Main Details
Name
COLLIER HEALTH SERVICES, INC.
Subdivision Name
Creekside Family Practice
Type
HRSA-Funded Health Center
Site ID
BPS-H80-010730
340B ID
CH04170D
Grant Number
H80CS00735
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/6/2015
Last Recertification Date
3/6/2018
Termination Date
Termination Reason
4/1/2019
Site closure
Contacts
Authorizing Official
Collier Health Services, Inc., d/b/a Healthcare Network of Southwest Florida
Mike Ellis, President/CEO
(239) 658-3158
Primary Contact
Collier Health Services, Inc., d/b/a Healthcare Network
John Fletcher, Chief Operating Officer & General Counsel
(239) 658-3060
Addresses
Street Address
1284 Creekside St
101
Naples, FL 34108-1949
Billing Address
Collier Health Services, Inc., d/b/a Healthcare Network of Southwest Florida
1454 Madison Ave W
Immokalee, FL 34142
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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