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CH01006F FAIR HAVEN COMMUNITY HEALTH CLINIC INC (Active)
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Main Details
Name
FAIR HAVEN COMMUNITY HEALTH CLINIC INC
Subdivision Name
Clinton Avenue School Based Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-010636
340B ID
CH01006F
Grant Number
H80CS00741
Additional Details
Current Program Status
Active
Registration Date
9/13/2010
Participating Start Date
1/1/2016
Participating Approval Date
9/14/2010
Last Recertification Date
2/15/2025
Contacts
Authorizing Official
Fair Haven Community Health Clinic, Inc.
SUZANNE LAGARDE, CEO
(203) 752-5129
Primary Contact
Fair Haven Community Health Clinic
Manan Dave, Compliance Officer
(203) 777-7411 Ext: 5198
Addresses
Street Address
293 Clinton Ave
NEW HAVEN, CT 06513-2814
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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11/23/15 participating 10/1/10 until terminated 4/1/13, reinstated effective 1/1/16
11/23/2015
April 2025
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