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CHC26576-08 Five Rivers Health Centers (Terminated)
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Main Details
Name
Five Rivers Health Centers
Subdivision Name
Five Rivers Pediatric Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-028208
340B ID
CHC26576-08
Grant Number
H80CS26576
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/21/2019
Last Recertification Date
2/9/2022
Termination Date
Termination Reason
1/1/2023
Site closure
Contacts
Authorizing Official
Five Rivers Health Centers
Diane M. Cummins, Chief Operating Officer
(937) 281-5942
Primary Contact
Five Rivers Health Centers
John Howard Tomlin, Pharmacy Director
(937) 281-6825
Addresses
Street Address
30 East Apple Street, Ground Floor
Dayton, OH 45409-2939
Billing Address
Five Rivers Health Centers
2261 Philadelphia Drive
Dayton, OH 45406
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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