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CH05711C THIRD STREET COMMUNITY CLINIC (ToBeTerminated)
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Main Details
Name
THIRD STREET COMMUNITY CLINIC
Subdivision Name
Hawkins Medical Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-012667
340B ID
CH05711C
Grant Number
H80CS00581
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/15/2013
Participating Start Date
10/1/2013
Participating Approval Date
8/27/2013
Last Recertification Date
2/27/2025
Termination Date
Termination Reason
7/1/2025
Site closure
Contacts
Authorizing Official
Third Street Community Clinic
Peggy Anderson, CEO
(419) 526-7880
Primary Contact
Third Street Community Clinic
Jason Bilyj, Director of Pharmacy
(419) 527-4105
Addresses
Street Address
2131 Park Avenue West
STE 200
Ontario, OH 44906
Billing Address
Third Street Community Clinic, Inc
1404 Park Ave W
Suite 2
Mansfield, OH 44906
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
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