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FQHCLA219 FORDLAND CLINIC INC (Terminated)
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Main Details
Name
FORDLAND CLINIC INC
Subdivision Name
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-009867
340B ID
FQHCLA219
Grant Number
LALCS00078
Additional Details
Current Program Status
Terminated
Registration Date
5/31/2007
Participating Start Date
7/1/2007
Participating Approval Date
6/5/2007
Last Recertification Date
2/10/2015
Termination Date
Termination Reason
4/1/2016
Change of covered entity type
Contacts
Authorizing Official
Fordland
Robert Marsh, Exec. Director
(417) 767-2273 Ext: 2021
Primary Contact
JOAN TWITON, CFO
(417) 767-2273 Ext: 2022
Addresses
Street Address
1059 BARTON DRIVE
FORDLAND, MO 65652
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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