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CH04021L CENTRAL FLORIDA HEALTH CARE, INC. (Terminated)
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Main Details
Name
CENTRAL FLORIDA HEALTH CARE, INC.
Subdivision Name
CFHC Lake Wales Medical and Dental
Type
HRSA-Funded Health Center
Site ID
BPS-H80-015035
340B ID
CH04021L
Grant Number
H80CS00423
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2016
Participating Start Date
10/1/2016
Participating Approval Date
7/21/2016
Last Recertification Date
2/17/2017
Termination Date
Termination Reason
4/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
CENTRAL FLORIDA HEALTH CARE INC
ANN CLAUSSEN, CEO
(863) 291-5115
Primary Contact
CENTRAL FLORIDA HEALTH CARE INC
MISILENE FULSE, DIRECTOR OF PHARMACY
(863) 449-0751
Addresses
Street Address
225 Lincoln Ave.
Lake Wales, FL 33853-3546
Billing Address
Central Florida Health Care Inc.
47 5th Street Northwest
Winter Haven, FL 33881
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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May 2025
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