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CH03126C SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC. (Terminated)
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Main Details
Name
SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.
Subdivision Name
DBA HENRIETTA JOHNSON MEDICAL CENTER @ EASTSIDE
Type
HRSA-Funded Health Center
Site ID
BPS-H80-012295
340B ID
CH03126C
Grant Number
H80CS00385
Additional Details
Current Program Status
Terminated
Registration Date
4/2/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/2/2018
Last Recertification Date
2/25/2021
Termination Date
Termination Reason
4/1/2022
Site closure
Contacts
Authorizing Official
Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center
Shay Scott, CEO
(302) 655-6187 Ext: 230
Primary Contact
Southbridge Medical Advisory Council, dba Henrietta Johnson Medical Center
Deborah M. Parker, Chief Operating Officer
(302) 655-6187 Ext: 235
Addresses
Street Address
600 N Lombard Street
WILMINGTON, DE 19801
Billing Address
SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.
601 NEW CASTLE AVENUE
WILMINGTON, DE 19801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Participating from effective date (11/18/2005) until terminated effective date ( 04/01/218) reinstatement date (07/01/2018) 11/18/2005 11/18/2005
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10/12/10 ADDED BILLING ADD
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