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CH04563DD Gaston Family Health Services, Inc. (Terminated)
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Main Details
Name
Gaston Family Health Services, Inc.
Subdivision Name
Kintegra Family Medicine - Shelby Lee St
Type
HRSA-Funded Health Center
Site ID
BPS-H80-035109
340B ID
CH04563DD
Grant Number
H80CS00293
Additional Details
Current Program Status
Terminated
Registration Date
8/17/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/23/2022
Last Recertification Date
2/16/2023
Termination Date
Termination Reason
4/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Gaston Family Health Services
Robert Spencer, CEO
(704) 616-2245
Primary Contact
Gaston Family Health Services, Inc.
Marvin Patrick Allen, Director, Pharmacy Services
(704) 772-4642
Addresses
Street Address
114 Lee St
Shelby, NC 28150-3839
Billing Address
Gaston Family Health Services, Inc.
200 East Second Avenue
Gastonia, NC 28052
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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