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FQHCLA458D INTERCOMMUNITY INC (Active)
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Main Details
Name
INTERCOMMUNITY INC
Subdivision Name
InterCommunity Mobile Van #1
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-033153
340B ID
FQHCLA458D
Grant Number
LALCS00170
Additional Details
Current Program Status
Active
Registration Date
1/9/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/5/2024
Last Recertification Date
2/25/2025
Contacts
Authorizing Official
InterCommunity
Kim Beauregard, CEO
(860) 569-5900
Primary Contact
InterCommunity Health Care
Aneta Godlewski, VP
(860) 805-8428
Addresses
Street Address
16 Coventry St Bldg
Hartford, CT 06112-1524
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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