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CH06192P 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 - Fair Park Middle
Type
HRSA-Funded Health Center
Site ID
BPS-H80-035325
340B ID
CH06192P
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
2/18/2025
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
3222 Greenwood Rd
Shreveport, LA 71109-5235
Billing Address
David Raines Community Health Center
3041 DR MLK Jr Dr
Shreveport, LA 71107
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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