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CH042377C Northeast Florida Health Services Inc (Active)
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Main Details
Name
Northeast Florida Health Services Inc
Subdivision Name
Family Health Source East
Type
HRSA-Funded Health Center
Site ID
BPS-H80-019454
340B ID
CH042377C
Grant Number
H80CS02520
Additional Details
Current Program Status
Active
Registration Date
3/6/2018
Participating Start Date
4/1/2018
Participating Approval Date
3/6/2018
Last Recertification Date
2/20/2025
Contacts
Authorizing Official
Northeast Florida Health Services, inc,
Laurie Asbury, CEO
(386) 624-1054
Primary Contact
Family Health Source
Hipolito Valdez, CFO
(386) 414-9601
Addresses
Street Address
801 Beville Road
South Daytona, FL 32119
Billing Address
Northeast Florida Health Services
1205 S Woodland Blvd
Suite 3
Deland, FL 32720
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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