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CH0617170 FOURTH WARD CLINIC (Terminated)
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Main Details
Name
FOURTH WARD CLINIC
Subdivision Name
Fourth Ward Clinic, Inc. d.b.a. GOOD NEIGHBOR HEALTHCARE CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-000260
340B ID
CH0617170
Grant Number
H80CS06445
Additional Details
Current Program Status
Terminated
Registration Date
11/21/2005
Participating Start Date
11/21/2005
Participating Approval Date
11/21/2005
Last Recertification Date
2/10/2017
Termination Date
Termination Reason
10/1/2017
Loss of qualifying grant/support
Contacts
Authorizing Official
Roberta Rodriguez, Staff Accountant
(713) 409-5009
Primary Contact
Iliana Perez, Director Operations
(713) 387-7169
Addresses
Street Address
190 HEIGHTS BLVD
HOUSTON, TX 77007-3729
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History
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4/29/2008-UPDATED ADDRESS (WAS 277 WEST GRAY,77019) 7/8/11 - CHANGED AO PHONE NUMBER AND CONTACT PERSON FROM JANET S. DONATH.
07/08/2011
4/29/2008-UPDATED ADDRESS (WAS 277 WEST GRAY,77019) 7/8/11 - CHANGED AO PHONE NUMBER AND CONTACT PERSON FROM JANET S. DONATH.
07/08/2011
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