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FQHC638520 FOREST COUNTY POTAWATOMI HEALTH AND WELLNESS CENTER (Active)
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Main Details
Name
FOREST COUNTY POTAWATOMI HEALTH AND WELLNESS CENTER
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638520
Additional Details
Current Program Status
Active
Registration Date
4/26/2006
Participating Start Date
7/1/2006
Participating Approval Date
5/1/2006
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Forest County Potawatomi Health & Wellness Center
Tom Boelter, Health Division Administrator
(715) 478-4340
Primary Contact
POTAWATOMI HEALTH & WELLNESS PHARMACY
Joseph Henry Bosin, Pharmacy Director
(715) 478-4347
Addresses
Street Address
8201 MISH KO SWEN DR.
CRANDON, WI 54520
Billing Address
FOREST COUNTY POTAWATOMI HEALTH AND WELLNESS CENTER
PO BOX 340
CRANDON, WI 54520
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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