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CHC00341-09 PRIMECARE COMMUNITY HEALTH INC (Terminated)
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Main Details
Name
PRIMECARE COMMUNITY HEALTH INC
Subdivision Name
Elston
Type
HRSA-Funded Health Center
Site ID
BPS-H80-038466
340B ID
CHC00341-09
Grant Number
H80CS00341
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2024
Participating Start Date
10/1/2024
Participating Approval Date
9/12/2024
Last Recertification Date
Termination Date
Termination Reason
1/1/2025
Site closure
Contacts
Authorizing Official
PrimeCare Community Health
Michael C Holtrop, Chief Financial Officer
(616) 482-9892
Primary Contact
PRIMECARE COMMUNITY HEALTH INC
Kenzie Keisler, Interim 340B Compliance Analyst
(803) 465-2011
Addresses
Street Address
1308 N Elston Ave
Chicago, IL 60642-2416
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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