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FQHCLA362K CLOVER FORK OUTPATIENT MEDICAL PROJECT INC (Active)
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Main Details
Name
CLOVER FORK OUTPATIENT MEDICAL PROJECT INC
Subdivision Name
Clover Fork Clinic Mobile Unit #1
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-038567
340B ID
FQHCLA362K
Grant Number
LALCS31536
Additional Details
Current Program Status
Active
Registration Date
1/8/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/29/2025
Last Recertification Date
Contacts
Authorizing Official
Clover Fork Outpatient Medical Project INC
Jack Miniard, Chief Executive Officer
(606) 837-2108 Ext: 122
Primary Contact
Clover Fork Outpatient Medical Project INC
Linda C Blevins, Chief financial Officer
(606) 837-2108 Ext: 5114
Addresses
Street Address
101 Chad St
Evarts, KY 40828-8200
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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