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CH06019B OUTPATIENT MEDICAL CENTER, INC. (Terminated)
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Main Details
Name
OUTPATIENT MEDICAL CENTER, INC.
Subdivision Name
LEESVILLE HEALTH CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001991
340B ID
CH06019B
Grant Number
H80CS00513
Additional Details
Current Program Status
Terminated
Registration Date
1/17/2006
Participating Start Date
4/1/2006
Participating Approval Date
1/17/2006
Last Recertification Date
3/6/2018
Termination Date
Termination Reason
4/1/2018
Site closure
Contacts
Authorizing Official
Outpatient Medical Center
Carl I. Walters II, CEO
(318) 357-2055
Primary Contact
Outpatient Medical Center
Rosie Kye, Site Coordinator/Compliance Officer
(318) 574-5876
Addresses
Street Address
900 N 5th St STE 14
Leesville, LA 71446-3530
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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