340B Drug Pricing Program Database
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CHC26566-30 Jane Pauley Community Health Center, Inc. (ToBeTerminated)
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Main Details
Name
Jane Pauley Community Health Center, Inc.
Subdivision Name
Jane Pauley Community Health Center at LaFountain Street Kokomo
Type
HRSA-Funded Health Center
Site ID
BPS-H80-038276
340B ID
CHC26566-30
Grant Number
H80CS26566
Additional Details
Current Program Status
ToBeTerminated
Registration Date
10/1/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/1/2024
Last Recertification Date
2/10/2025
Termination Date
Termination Reason
7/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Jane Pauley Community Health Center
Aaron Knapp, Dir of Pharmacy Operations
(812) 632-0917
Primary Contact
Jane Pauley Community Health Center
Dale Marion, 340B Program Manager
(317) 552-0690
Addresses
Street Address
3510 S Lafountain St
Kokomo, IN 46902-3803
Billing Address
Jane Pauley Community Health Center, Inc
1503 N Mitthoefer Rd
Indianapolis, IN 46229
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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