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FP212174 DRUID FAMILY HEALTH CENTER (Active)
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Main Details
Name
DRUID FAMILY HEALTH CENTER
Subdivision Name
BALTIMORE CITY HEALTH DEPARTMENT
Type
Family Planning (Title X only)
340B ID
FP212174
Grant Number
FPHPA006494
Additional Details
Current Program Status
Active
Registration Date
1/11/2021
Participating Start Date
4/1/2021
Participating Approval Date
3/3/2021
Last Recertification Date
5/9/2024
Contacts
Authorizing Official
BALTIMORE CITY HEALTH DEPARTMENT
Shirley D Rivers, Director, Adolescent & Reproductive Health
(410) 396-0186
Primary Contact
BALTIMORE CITY HEALTH DEPARTMENT
Dawayne Calhoun, Medical Claims Processor
(410) 396-0186
Addresses
Street Address
1515 W NORTH AVE
BALTIMORE, MD 21217
Billing Address
DRUID FAMILY HEALTH CENTER
1001 E. FAYETTE STREET
BALTIMORE, MD 21202
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date: (01/01/1998) until terminated effective date: (07/01/2020(), reinstatement effective date: (04/01/2021)
01/25/2021
3/1/12 Added medicaid #; 9/21/2010- ADDED BILLING ADD.3/31/2006 ADDED SUB-DIV NAME
03/01/2012
9/21/2010- ADDED BILLING ADD.3/31/2006 ADDED SUB-DIV NAME
09/22/2010
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