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CH02426B BronxCare Health Integrated Services System, Inc. (Terminated)
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Main Details
Name
BronxCare Health Integrated Services System, Inc.
Subdivision Name
BRONXCARE CROTONA PARK FAMILY PRACTICE
Type
HRSA-Funded Health Center
Site ID
BPS-H80-004751
340B ID
CH02426B
Grant Number
H80CS00625
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
2/4/2022
Termination Date
Termination Reason
4/1/2022
Site closure
Contacts
Authorizing Official
BronxCare Health Integrated Health Care Solutions
Crystal D Jordan, Executive Director
(718) 466-6072
Primary Contact
BronxCare Health System
Kyoung-Sil Kang, Director of Pharmacy
(718) 518-5021
Addresses
Street Address
1591 Fulton Ave
Bronx, NY 10457-8234
Billing Address
DR MARTIN LUTHER KING JR HEALTH CENTER
1265 FRANKLIN AVENUE
BRONX, NY 10456
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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