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CH05175AP ACCESS COMMUNITY HEALTH NETWORK (Terminated)
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Main Details
Name
ACCESS COMMUNITY HEALTH NETWORK
Subdivision Name
ACCESS Centro Medico San Rafael
Type
HRSA-Funded Health Center
Site ID
BPS-H80-003776
340B ID
CH05175AP
Grant Number
H80CS00834
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2003
Participating Start Date
7/1/2003
Participating Approval Date
10/10/2003
Last Recertification Date
1/31/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Access Community Health Network
Mahomed Ouedraogo, Chief Executive Officer
(312) 526-2360
Primary Contact
Access Community Health Network
Kenneth Pacheco, Director, Pharmacy and Lab Services
(312) 526-2107
Addresses
Street Address
3204 W 26th St
Chicago, IL 60623-4031
Billing Address
ACCESS COMMUNITY HEALTH NETWORK
600 W Fulton St
Suite 200
CHICAGO, IL 60661
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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7/13/10 ADDED BILL TO; NEW SATELLITE
03/18/2014
7/13/10 ADDED BILL TO; NEW SATELLITE
10/10/2003
7/13/10 ADDED BILL TO; NEW SATELLITE
10/10/2003
May 2025
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