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CHC24098-00 SOUTHERN ILLINOIS UNIVERSITY (Active)
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Main Details
Name
SOUTHERN ILLINOIS UNIVERSITY
Subdivision Name
SIU Center for Family Medicine
Type
HRSA-Funded Health Center
Site ID
BPS-H80-011680
340B ID
CHC24098-00
Grant Number
H80CS24098
Additional Details
Current Program Status
Active
Registration Date
10/2/2012
Participating Start Date
1/1/2013
Participating Approval Date
10/10/2012
Last Recertification Date
2/11/2025
Contacts
Authorizing Official
SIU Center for Family Medicine
Iris Elenora Wesley, CEO
(217) 757-8116
Primary Contact
SIU Center for Family Medicine
Michael Black, CFO
(217) 747-6470
Addresses
Street Address
520 N 4th St
Springfield, IL 62702-5238
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
April 2025
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