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CH0112200 INDIAN STREAM HEALTH CENTER (Terminated)
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Main Details
Name
INDIAN STREAM HEALTH CENTER
Subdivision Name
INDIAN STREAM HEALTH CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-005117
340B ID
CH0112200
Grant Number
H80CS06655
Additional Details
Current Program Status
Terminated
Registration Date
6/1/2007
Participating Start Date
7/1/2007
Participating Approval Date
6/5/2007
Last Recertification Date
2/24/2021
Termination Date
Termination Reason
4/1/2022
Failure to recertify
Contacts
Authorizing Official
Indian Stream Health Center
Sergio Zullich, CEO
(603) 237-4170
Primary Contact
Indian Stream Health Center
Lori E Morann, Practice Manager
(603) 388-2439 Ext: 6033882439
Addresses
Street Address
141 Corliss Ln
Colebrook, NH 03576-3206
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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