Covered Entity Details

FP025687 MARTHAS VINEYARD FP (Terminated)

Main Details

Name

MARTHAS VINEYARD FP

Subdivision Name

Type

Family Planning (Title X only)

340B ID

FP025687

Grant Number

FPHPA016029

Additional Details

Current Program Status

Terminated

Registration Date

1/1/1998

Participating Start Date

1/1/1998

Participating Approval Date

3/5/2004

Last Recertification Date

5/28/2019

Termination Date
Termination Reason

10/1/2019
Change of covered entity type (non-hospital)

Contacts

Authorizing Official

Health Imperatives
Emily Gold, Director of Reproductive Health Services
(508) 274-6541

Primary Contact

Health Imperatives
Jessica Cisternelli, Director of Operations
(508) 367-1963

Addresses

Street Address

517 STATE RD
VINEYARD HAVEN, MA 02568

Billing Address

HEALTH IMPERATIVES, INC
942 W. CHESTNUT ST.
BROCKTON, MA 02301

Comment	Last Updated On
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2/14/12 Added NPI # 1,2; 2/2/10 UPDATED ADDR (WAS 322 STATE RD PO BOX 909); 2/2/10 UPDATED SHIP TO (WAS HEALTH CARE OF SE MA); 2/2/10 UPDATED BILL TO (WAS HEALTH CARE OF SE MA); 5/1/2006 UPDATED ADDR (WAS 92 STATE RD PO BOX 909); 3/12/06 ADDED BILL TO; 3/12/06 ADDED SHIP TO;	02/14/2012
2/2/10 UPDATED ADDR (WAS 322 STATE RD PO BOX 909); 2/2/10 UPDATED SHIP TO (WAS HEALTH CARE OF SE MA); 2/2/10 UPDATED BILL TO (WAS HEALTH CARE OF SE MA); 5/1/2006 UPDATED ADDR (WAS 92 STATE RD PO BOX 909); 3/12/06 ADDED BILL TO; 3/12/06 ADDED SHIP TO;	02/02/2010

340B Drug Pricing Program Database