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FQHCLA443A SPACE COAST HEALTH CENTERS INC (Active)
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Main Details
Name
SPACE COAST HEALTH CENTERS INC
Subdivision Name
Space Coast Health Centers Primary Care - Port St. John
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-034892
340B ID
FQHCLA443A
Grant Number
LALCS45787
Additional Details
Current Program Status
Active
Registration Date
1/9/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/11/2023
Last Recertification Date
2/21/2025
Contacts
Authorizing Official
Space Coast Health Centers
Arvin H Lewis, CEO
(321) 346-8031
Primary Contact
Space Coast Health Centers Inc
Wanda Gerson, Director of Quality
(321) 346-8031
Addresses
Street Address
5005 Port St John Pkwy Ste 2400
Cocoa, FL 32927-4305
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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May 2025
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