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CH040650 PARK DUVALLE COMMUNITY HEALTH CENTER, INC. (Active)
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Main Details
Name
PARK DUVALLE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Park DuValle Community Health Center, Inc.
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001342
340B ID
CH040650
Grant Number
H80CS00083
Additional Details
Current Program Status
Active
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
8/23/2004
Last Recertification Date
2/12/2025
Contacts
Authorizing Official
PARK DUVALLE COMMUNITY HEALTH CENTER
Swannie Jett, CEO
(502) 774-4401
Primary Contact
Park Duvalle Community Health Center
Tyler Leonhardt, 340b Director
(502) 774-4401 Ext: 1161
Addresses
Street Address
3015 Wilson Ave
Louisville, KY 40211-1969
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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ENTITY NAME CORRECTION, NEW CONTACT INFO, CHANGE IN MEDICAID
08/23/2004
April 2025
April 2025
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