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CH05276L CRUSADERS CENTRAL CLINIC ASSOCIATION (Active)
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Main Details
Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Crusader Community Health Loves Park
Type
HRSA-Funded Health Center
Site ID
BPS-H80-010923
340B ID
CH05276L
Grant Number
H80CS00113
Additional Details
Current Program Status
Active
Registration Date
1/9/2013
Participating Start Date
4/1/2013
Participating Approval Date
2/15/2013
Last Recertification Date
2/19/2025
Contacts
Authorizing Official
Crusader Community Health
Samuel Miller, President/CEO
(815) 490-1600
Primary Contact
Crusaders Central Clinic Association
Millard Washington, 340B Program Manager
(815) 490-1418
Addresses
Street Address
6115 N 2nd St
Loves Park, IL 61111
Billing Address
Crusaders Central Clinic Association
1200 W State St
Rockford, IL 61102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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2-13-13 CEO emailed F. Nguyen attesting to be the Signed By official
02/15/2013
April 2025
April 2025
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