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CH07213A NORTHWEST HEALTH SERVICES, INC. (Active)
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Main Details
Name
NORTHWEST HEALTH SERVICES, INC.
Subdivision Name
King City Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-005680
340B ID
CH07213A
Grant Number
H80CS00671
Additional Details
Current Program Status
Active
Registration Date
4/1/1997
Participating Start Date
4/1/1997
Participating Approval Date
4/14/2004
Last Recertification Date
2/19/2025
Contacts
Authorizing Official
Northwest Health Services
Matt Younger, CEO
(816) 307-5303
Primary Contact
Northwest Health Services
Miranda Phillips, Director of Pharmacy
(816) 385-5997
Addresses
Street Address
305 Rhode Island St
King City, MO 64463-9622
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Requester must submit online-change request for each entity. 10/12/05 REMOVED MEDICAID # (WAS 502111271)
10/18/2012
10/12/05 REMOVED MEDICAID # (WAS 502111271)
01/11/2010
April 2025
April 2025
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