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CH04126A ERLANGER HEALTH SYSTEM SOUTHSIDE/DODSON AVE CHC (Active)
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Main Details
Name
ERLANGER HEALTH SYSTEM SOUTHSIDE/DODSON AVE CHC
Subdivision Name
DODSON AVENUE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001395
340B ID
CH04126A
Grant Number
H80CS00091
Additional Details
Current Program Status
Active
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
1/21/2010
Last Recertification Date
2/19/2025
Contacts
Authorizing Official
Erlanger Health
Misty Brackett, VP Revenue Cycle
(423) 778-9775
Primary Contact
Erlanger SSDA Health Centers
Angel Moore, APDA
(423) 778-2805
Addresses
Street Address
1200 DODSON AVE
CHATTANOOGA, TN 37406
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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12/21/05 UPDATED ENTITY NAME
01/21/2010
April 2025
April 2025
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