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CH03224R PENINSULA INSTITUTE FOR COMMUNITY HEALTH, INC (Terminated)
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Main Details
Name
PENINSULA INSTITUTE FOR COMMUNITY HEALTH, INC
Subdivision Name
Southeastern Virginia Health System @ Western Tidewater Community Services Board
Type
HRSA-Funded Health Center
Site ID
BPS-H80-017059
340B ID
CH03224R
Grant Number
H80CS00073
Additional Details
Current Program Status
Terminated
Registration Date
4/7/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/7/2016
Last Recertification Date
1/31/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Peninsula Institue for Community Health
ANGELA FUTRELL, CEO
(757) 591-0643 Ext: 1120
Primary Contact
Peninsula Institute for Community Health
VALDA BRANCH, COO
(757) 223-7007
Addresses
Street Address
5268 Godwin Boulevard
Suffolk, VA 23434-8027
Billing Address
Southeastern Virginia Health System
1033 28th Street
Newport News, VA 23607
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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