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CHC24133-00 MAPLE CITY HEALTH CARE CENTER, INC. (Active)
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Main Details
Name
MAPLE CITY HEALTH CARE CENTER, INC.
Subdivision Name
Maple City Health Care Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-011740
340B ID
CHC24133-00
Grant Number
H80CS24133
Additional Details
Current Program Status
Active
Registration Date
1/14/2013
Participating Start Date
4/1/2013
Participating Approval Date
2/6/2013
Last Recertification Date
2/14/2025
Contacts
Authorizing Official
Maple City Health Care Center
Jamie Alvarez, CFO
(574) 534-3300
Primary Contact
Maple City Health Care Center
Isamar Vivanco, med tech
(574) 903-3785
Addresses
Street Address
213 Middlebury Street
Goshen, IN 46528-2956
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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2/6/13 Formerly enrolled as an FQHCLA (FQHCLA273), received grant funding so entity type had to be changed, the site is continuously eligible for discounted drugs (FQHCLA273 is eligible thru 3/31/13, CHC24133-00 is eligible starting 4/1/13)
02/06/2013
April 2025
April 2025
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