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CH05302Y WEST SIDE COMMUNITY HEALTH SERVICES, INC. (Active)
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Main Details
Name
WEST SIDE COMMUNITY HEALTH SERVICES, INC.
Subdivision Name
MCDONOUGH HOMES CLINIC
Type
HRSA-Funded Health Center
Site ID
BPS-H80-000730
340B ID
CH05302Y
Grant Number
H80CS00790
Additional Details
Current Program Status
Active
Registration Date
4/1/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/20/2018
Last Recertification Date
2/14/2025
Contacts
Authorizing Official
West Side Community Health Services
Reuben Moore, President and Executive Officer
(651) 602-7536
Primary Contact
West Side Community Health Services
Kenneth Scott Nelson, Director of Pharmacy
(715) 566-0729
Addresses
Street Address
1544 Timberlake Rd
Saint Paul, MN 55117-3946
Billing Address
West Side Community Health Services, Inc.
153 Cesar Chavez Street
St. Paul, MN 55107
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Participation started on 7/1/2013; terminated on 4/1/2018; Reinstated on 7/1/2018.
04/20/2018
Participation started on 5/22/2013; terminated on 4/1/2018; Reinstated on 7/1/2018.
04/06/2018
April 2025
April 2025
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