Covered Entity Details

Recovery Mobile Clinic (Pending) - information as of 4/25/2025 7:26:13 PM

Main Details

Name

Recovery Mobile Clinic

Subdivision Name

Mobile Medical SUV #3

Type

Sexually Transmitted Diseases

340B ID

Grant Number

NH25PS005170

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

In-Kind products or services (see note below; must have been purchased with section 318 funds)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.
The Michigan Department for Health and Human Services provides prepaid labs and STI medications for Recovery Mobile Clinic.
4/1/2025

Additional Details

Current Program Status

Pending

Registration Date

4/14/2025

Participating Start Date

Participating Approval Date

Last Recertification Date

Notice of Funding Opportunity (NOFO) Number

PS19-1901

Contacts

Authorizing Official

Recovery Mobile Clinic
Jordana Latozas, President
(248) 567-2334

Primary Contact

Recovery Mobile Clinic
Carly LaForest, Office Manager
(248) 579-0334

Addresses

Street Address

4706 PRODUCT DR
STE 1
WIXOM, MI 48393

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

History

Section	Field	Action	Activity	Value After	Timestamp
Addresses	Main Address	Insert	New Registration	4706 PRODUCT DR STE 1 WIXOM, MI 48393	4/14/2025 3:57 PM
Details	Nature of Support: In Kind Support Description	Insert	New Registration	The Michigan Department for Health and Human Services provides prepaid labs and STI medications for Recovery Mobile Clinic.	4/14/2025 3:57 PM
Details	Nature Of Support	Insert	New Registration	In-Kind products or services (see note below; must have been purchased with section 318 funds)	4/14/2025 3:57 PM
Details	Nature of Support: Support Received From Date	Insert	New Registration	4/1/2025 12:00:00 AM	4/14/2025 3:57 PM
Details	Nature of Support: Support Received To Date	Insert	New Registration		4/14/2025 3:57 PM
Contacts	Authorizing Official	Insert	New Registration	Latozas, Jordana President Recovery Mobile Clinic 2485672334	4/14/2025 3:57 PM
Contacts	Primary Contact	Insert	New Registration	LaForest, Carly Office Manager Recovery Mobile Clinic 2485790334	4/14/2025 3:57 PM
Details	Assistance Received From Date	Insert	New Registration		4/14/2025 3:57 PM
Details	Assistance Received To Date	Insert	New Registration		4/14/2025 3:57 PM
Details	Last Recertification Date	Insert	New Registration		4/14/2025 3:57 PM
Details	Grant Number	Insert	New Registration	NH25PS005170	4/14/2025 3:57 PM
Details	340B ID	Insert	New Registration		4/14/2025 3:57 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration		4/14/2025 3:57 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration		4/14/2025 3:57 PM
Details	Medicare Provider Number	Insert	New Registration		4/14/2025 3:57 PM
Details	Entity Name	Insert	New Registration	Recovery Mobile Clinic	4/14/2025 3:57 PM
Details	NOFO Number	Insert	New Registration	PS19-1901	4/14/2025 3:57 PM
Details	Program Code	Insert	New Registration	STD	4/14/2025 3:57 PM
Details	Entity Subname	Insert	New Registration	Mobile Medical SUV #3	4/14/2025 3:57 PM
Dates	Participating Approval Date	Insert	New Registration		4/14/2025 3:57 PM
Details	State	Insert	New Registration	Pending	4/14/2025 3:57 PM
Dates	Registration Date	Insert	New Registration	4/14/2025 3:57:50 PM	4/14/2025 3:57 PM
Dates	Signed By Date	Insert	New Registration		4/14/2025 3:57 PM
Dates	Start Date	Insert	New Registration		4/14/2025 3:57 PM
Terminations	Termination Comments	Insert	New Registration		4/14/2025 3:57 PM
Terminations	Termination Date	Insert	New Registration		4/14/2025 3:57 PM
Terminations	Termination Effective Date	Insert	New Registration		4/14/2025 3:57 PM
Terminations	Termination Reason	Insert	New Registration		4/14/2025 3:57 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History