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CH05276K CRUSADERS CENTRAL CLINIC ASSOCIATION (Active)
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Main Details
Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Crusader Clinic - Belvidere
Type
HRSA-Funded Health Center
Site ID
BPS-H80-004361
340B ID
CH05276K
Grant Number
H80CS00113
Additional Details
Current Program Status
Active
Registration Date
4/1/2004
Participating Start Date
4/1/2004
Participating Approval Date
3/16/2004
Last Recertification Date
2/18/2025
Contacts
Authorizing Official
Crusader Community Health
Samuel Miller, President/CEO
(815) 490-1600
Primary Contact
Crusaders Central Clinic Association
Millard Washington, 340B Program Manager
(815) 490-1418
Addresses
Street Address
1050 Logan Ave
Belvidere, IL 61008-3966
Billing Address
Crusaders Central Clinic Association
1200 W State St
Rockford, IL 61102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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6/18/09 SUB DIV NAME CHANGE (WAS BOONE COUNTY HEALTH DEPT.) NEW SITE 04/01/2004
01/24/2011
April 2025
April 2025
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