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CHC08784-01 LAKES COMMUNITY HEALTH CENTER, INC., THE (Terminated)
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Main Details
Name
LAKES COMMUNITY HEALTH CENTER, INC., THE
Subdivision Name
NorthLakes - Hayward - Dental
Type
HRSA-Funded Health Center
Site ID
BPS-H80-012595
340B ID
CHC08784-01
Grant Number
H80CS08784
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2013
Participating Start Date
10/1/2013
Participating Approval Date
8/20/2013
Last Recertification Date
2/8/2018
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
NorthLakes Community Clinic
Jason Akl, COO
(715) 372-5001 Ext: 1211
Primary Contact
The Lakes Community Health Center
Christine Dryer, Pharmacy Director
(715) 372-5011
Addresses
Street Address
15910 W Company Lake Road
Hayward, WI 54843-5335
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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