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CH03074D ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES (Terminated)
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Main Details
Name
ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES
Subdivision Name
DAVENPORT CLINIC
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001503
340B ID
CH03074D
Grant Number
H80CS00604
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2001
Participating Start Date
4/1/2001
Participating Approval Date
2/6/2004
Last Recertification Date
2/14/2017
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
St Charles Health Council, Inc
MALCOLM PERDUE, CEO
(276) 546-5310
Primary Contact
St Charles Health Council, Inc
MALCOLM PERDUE, CEO
(276) 546-5310
Addresses
Street Address
3837 HELEN HENDERSON HWY
DAVENPORT, VA 24239
Billing Address
ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES
276 Fieldstone Drive
Jonesville, VA 24263
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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9/23/10 UPDATED PHYS ADD (WAS PO BOX 309, ROUTE 80, DAVENPORT, VA), ADDED SHIP-TO ADD
09/23/2010
June 2025
June 2025
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