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HV00140 Southwest Boulevard Family Health Care (Terminated)
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Main Details
Name
Southwest Boulevard Family Health Care
Subdivision Name
Type
Ryan White Part C
340B ID
HV00140
Grant Number
H76HA00140
Additional Details
Current Program Status
Terminated
Registration Date
10/3/2012
Participating Start Date
1/1/2013
Participating Approval Date
11/8/2012
Last Recertification Date
2/25/2019
Time Period the Assistance was Received
Termination Date
Termination Reason
4/1/2020
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Southwest boulevard Family Health Care services of Greater Kansas City, Inc.
Kevin Dennis, Program Administrator
(913) 722-3100
Primary Contact
Doc Shop, P.A.
Sharon D Lee, President
(913) 362-0220
Addresses
Street Address
340 Southwest Boulevard
Kansas City, KS 66103
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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11/7/12 - Reviewed registration and forwarded to IS for approval.
11/07/2012
April 2025
April 2025
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