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CH01006Y FAIR HAVEN COMMUNITY HEALTH CLINIC, INC. (Active)
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Main Details
Name
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC.
Subdivision Name
Mary R. Tisko Elementary School
Type
HRSA-Funded Health Center
Site ID
BPS-H80-034414
340B ID
CH01006Y
Grant Number
H80CS00741
Additional Details
Current Program Status
Active
Registration Date
4/10/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/18/2024
Last Recertification Date
2/15/2025
Contacts
Authorizing Official
Fair Haven Community Health Clinic, Inc.
SUZANNE LAGARDE, CEO
(203) 752-5129
Primary Contact
Fair Haven Community Health Clinic
Manan Dave, Compliance Officer
(203) 777-7411 Ext: 5198
Addresses
Street Address
118 Damascus Rd
Branford, CT 06405-3979
Billing Address
Fair Haven Community Health Clinic
374 Grand ave
New Haven, CT 06513
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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