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CH051828E NORTHSHORE HEALTH CENTERS, INC (Terminated)
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Main Details
Name
NORTHSHORE HEALTH CENTERS, INC
Subdivision Name
NorthShore/Regional Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-009337
340B ID
CH051828E
Grant Number
H80CS02458
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2013
Participating Start Date
7/1/2013
Participating Approval Date
4/10/2013
Last Recertification Date
1/29/2019
Termination Date
Termination Reason
4/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
NorthShore Health Centers
JANICE WILSON, CEO
(219) 764-6052
Primary Contact
NorthShore Health Centers Inc.
Michael Wichlinski, Pharmacy Director
(219) 763-8112 Ext: 2301
Addresses
Street Address
8555 Taft Street
Merrillville, IN 46410
Billing Address
NorthShore Health Centers
PO Box 1430
Portage, IN 46368
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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04/08/13- Ready for approval
04/08/2013
April 2025
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