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FQHCLA302 Prohealth Rural Health Services, Inc (Terminated)
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Main Details
Name
Prohealth Rural Health Services, Inc
Subdivision Name
*
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-009792
340B ID
FQHCLA302
Grant Number
LALCS00061
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/14/2012
Last Recertification Date
2/9/2018
Termination Date
Termination Reason
4/1/2019
Failure to recertify
Contacts
Authorizing Official
Prohealth Rural Health Services, Inc.
Ray White, President
(615) 591-4750
Primary Contact
Prohealth Rural Health Services
Ruth Marcia Sirgo, Pharmacy Director
(615) 591-4750 Ext: 1029
Addresses
Street Address
1325 W. Main Street
Franklin, TN 37064-3786
Billing Address
Prohealth Rural Health services, inc.
P.O. Box 682589
Franklin, TN 37068-2589
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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