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CH05972AF AUNT MARTHA'S YOUTH SERVICE CENTER, INC. (Terminated)
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Main Details
Name
AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
Subdivision Name
Hazel Crest Women's Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-008536
340B ID
CH05972AF
Grant Number
H80CS00685
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2013
Participating Start Date
7/1/2014
Participating Approval Date
5/23/2013
Last Recertification Date
2/11/2019
Termination Date
Termination Reason
4/1/2019
Site closure
Contacts
Authorizing Official
Aunt Martha's
Audrey Pennington, Chief Operating Officer
(708) 747-7100
Primary Contact
Aunt Martha's Health & Wellness
Franca Liburdi, Director of Staff Relations & Resources
(708) 747-7100
Addresses
Street Address
17850 Kedzie Ave STE 3200
Hazel Crest, IL 60429-2086
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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6/9/14 enrolled 7/1/13 thru 3/31/14, not enrolled 4/1/14 thru 6/30/14 due to failure to recertify, reinstated based on on-line registration submitted in April 2014;
06/09/2014
June 2025
June 2025
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