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CH056960 SOUTHSIDE COMMUNITY HEALTH SERVICES (Active)
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Main Details
Name
SOUTHSIDE COMMUNITY HEALTH SERVICES
Subdivision Name
Type
HRSA-Funded Health Center
Site ID
BPS-H80-004961
340B ID
CH056960
Grant Number
H80CS00198
Additional Details
Current Program Status
Active
Registration Date
10/1/1996
Participating Start Date
10/1/1996
Participating Approval Date
10/18/2004
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Southside Community Health Services
Ann Cazaban, Executive Director
(612) 821-2025
Primary Contact
Southside Community Health Services
Raul Noriega, Medical Clinic Operations Manager
(612) 821-2548
Addresses
Street Address
4243 4TH AVE SOUTH
MINNEAPOLIS, MN 55409
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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NEW CONTACT INFO, NEW ADDRESS, REMOVED MEDICAID #
10/18/2004
April 2025
April 2025
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