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FQHCLA275 FAMILY HEALTH SERVICES OF ERIE COUNTY (Terminated)
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Main Details
Name
FAMILY HEALTH SERVICES OF ERIE COUNTY
Subdivision Name
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-010342
340B ID
FQHCLA275
Grant Number
LALCS00098
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2011
Participating Start Date
4/1/2011
Participating Approval Date
1/24/2011
Last Recertification Date
2/16/2015
Termination Date
Termination Reason
10/1/2015
Change of covered entity type
Contacts
Authorizing Official
Wilson Forney, Chief Executive Officer
(419) 502-2818
Primary Contact
Wilson Forney, Chief Executive Officer
(419) 502-2818
Addresses
Street Address
1912 HAYES AVENUE
SANDUSKY, OH 44870
Billing Address
FAMILY HEALTH SERVICES OF ERIE COUNTY
PO BOX 1526
SANDUSKY, OH 44871-1526
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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