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CH04479G PRIMARY HEALTH CARE CENTER OF DADE, INC. (Terminated)
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Main Details
Name
PRIMARY HEALTH CARE CENTER OF DADE, INC.
Subdivision Name
School Based Dental Mobile Unit
Type
HRSA-Funded Health Center
Site ID
BPS-H80-015046
340B ID
CH04479G
Grant Number
H80CS00649
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/10/2016
Last Recertification Date
2/9/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Primary Healthcare Center
Richard Christman, Chief Executive Officer
(706) 956-2665 Ext: 8549
Primary Contact
Primary Health Care Center of Dade, Inc.
Melanie Forsythe, COO
(706) 620-4494 Ext: 8541
Addresses
Street Address
87 S BURNT MILL RD
LA FAYETTE, GA 30728-4263
Billing Address
Primary Health Care Center of Dade, Inc.
100 Mitchell Road
Fort Oglethorpe, GA 30742
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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May 2025
May 2025
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