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CH057260 KENOSHA COMMUNITY HEALTH CENTER INC (Active)
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Main Details
Name
KENOSHA COMMUNITY HEALTH CENTER INC
Subdivision Name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
Site ID
BPS-H80-002076
340B ID
CH057260
Grant Number
H80CS00662
Additional Details
Current Program Status
Active
Registration Date
4/1/2005
Participating Start Date
4/1/2005
Participating Approval Date
3/1/2005
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Kenosha Community Health Center, Inc.
John Stampfl, Controller
(262) 771-3561
Primary Contact
Kenosha Community Health Center, Inc.
Mark P. Celebre, Director of Pharmacy
(262) 771-1920
Addresses
Street Address
4536 22nd Ave
Kenosha, WI 53140-5917
Billing Address
Kenosha Community Health Center
4006 Washington Road
Kenosha, WI 53144
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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1/11/12 - Added new bill to address. NEW SITE 04/01/2005
01/11/2012
NEW SITE 04/01/2005
06/19/2009
February 2025
February 2025
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