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CH05972AJ AUNT MARTHA'S YOUTH SERVICE CENTER, INC. (Terminated)
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Main Details
Name
AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
Subdivision Name
Roseland Community Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-018755
340B ID
CH05972AJ
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
3/7/2018
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
Stacy Baumgartner, Director of Performance Improvement
(708) 821-8410
Addresses
Street Address
45 W. 111th Street
3rd Floor West
Chicago, IL 60628
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
April 2025
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