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CHC00836-17 SOUTH CENTRAL PRIMARY CARE CENTER INC (Terminated)
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Main Details
Name
SOUTH CENTRAL PRIMARY CARE CENTER INC
Subdivision Name
Valdosta Internal Medicine
Type
HRSA-Funded Health Center
Site ID
BPS-H80-033586
340B ID
CHC00836-17
Grant Number
H80CS00836
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/3/2023
Last Recertification Date
1/29/2024
Termination Date
Termination Reason
10/1/2024
Site closure
Contacts
Authorizing Official
South Central Primary Care Center, Inc.
Robert B. Tucker, CEO
(229) 468-9166 Ext: 1
Primary Contact
South Central Primary Care Center, Inc.
Judy Swanson, Nurse Manager
(229) 468-9166
Addresses
Street Address
3308 Greystone Way
Valdosta, GA 31605-1096
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
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