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CH06192N DAVID RAINES COMMUNITY HEALTH CENTER INC (Active)
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Main Details
Name
DAVID RAINES COMMUNITY HEALTH CENTER INC
Subdivision Name
David Raines School Based Health Center- Keithville Elementary/Middle
Type
HRSA-Funded Health Center
Site ID
BPS-H80-035326
340B ID
CH06192N
Grant Number
H80CS00720
Additional Details
Current Program Status
Active
Registration Date
11/17/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/21/2022
Last Recertification Date
2/19/2025
Contacts
Authorizing Official
David Raines Community Health Centers
Myrtis Edwards, COO
(318) 227-3342
Primary Contact
David Raines Community Health Center
Randy Tynes, Pharmacist
(318) 227-3355
Addresses
Street Address
12201 Mansfield Rd
Keithville, LA 71047-8534
Billing Address
David Raines Community Health Center
3041 Dr. MLK Jr Dr
Shreveport, LA 71107-4705
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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