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CH057260A KENOSHA COMMUNITY HEALTH CENTER INC (Terminated)
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Main Details
Name
KENOSHA COMMUNITY HEALTH CENTER INC
Subdivision Name
Kenosha Community Center Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-011051
340B ID
CH057260A
Grant Number
H80CS00662
Additional Details
Current Program Status
Terminated
Registration Date
7/2/2013
Participating Start Date
10/1/2013
Participating Approval Date
8/20/2013
Last Recertification Date
2/22/2023
Termination Date
Termination Reason
4/1/2024
Site closure
Contacts
Authorizing Official
Kenosha Community Health Center, Inc.
John Stampfl, Controller
(262) 771-3561
Primary Contact
Kenosha Community Health Center Inc.
Paul Forchette, Risk Manager
(262) 764-3618
Addresses
Street Address
1330 52nd Street STE 205
Kenosha, WI 53140-3236
Billing Address
Kenosha Community Health Center
4006 Washington Road
Kenosha, WI 53144
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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