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CH04479K Primary Health Care Center Of Dade, Inc. (Terminated)
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Main Details
Name
Primary Health Care Center Of Dade, Inc.
Subdivision Name
Primary Health Care Center Rome
Type
HRSA-Funded Health Center
Site ID
BPS-H80-034176
340B ID
CH04479K
Grant Number
H80CS00649
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/13/2022
Last Recertification Date
2/1/2023
Termination Date
Termination Reason
4/1/2024
Site closure
Contacts
Authorizing Official
Primary Health Care Center of Dade, Inc.
DIANA U. ALLEN, CEO
(706) 620-4494 Ext: 8549
Primary Contact
Primary Health Care Center of Dade, Inc.
Melanie Forsythe, COO
(706) 620-4494 Ext: 8541
Addresses
Street Address
1400 Crane St SW
Rome, GA 30161-6333
Billing Address
Primary Health Care Center of Dade, Inc.
100 Mitchell Road
Fort Oglethorpe, GA 30742
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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