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CH01006D FAIR HAVEN COMMUNITY HEALTH CLINIC INC (Terminated)
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Main Details
Name
FAIR HAVEN COMMUNITY HEALTH CLINIC INC
Subdivision Name
RIVERSIDE ACADEMY
Type
HRSA-Funded Health Center
Site ID
BPS-H80-006050
340B ID
CH01006D
Grant Number
H80CS00741
Additional Details
Current Program Status
Terminated
Registration Date
8/17/2010
Participating Start Date
10/1/2010
Participating Approval Date
8/17/2010
Last Recertification Date
2/9/2017
Termination Date
Termination Reason
1/1/2018
Site closure
Contacts
Authorizing Official
Fair Haven Community Health Clinic, Inc.
SUZANNE LAGARDE, CEO
(203) 752-5129
Primary Contact
Fair Haven Community Health Center
Robyn Hoffmann, Compliance Officer
(203) 752-5198
Addresses
Street Address
560 ELLA T. GRASSO BLVD
NEW HAVEN, CT 06519-1827
Billing Address
FAIR HAVEN COMMUNITY HEALTH CENTER
374 GRAND AVENUE
NEW HAVEN, CT 06513
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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