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CHC26566-04 JANE PAULEY COMMUNITY HEALTH CENTER, INC. (Terminated)
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Main Details
Name
JANE PAULEY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Jane Pauley Community Health Center at Brook Park
Type
HRSA-Funded Health Center
Site ID
BPS-H80-013301
340B ID
CHC26566-04
Grant Number
H80CS26566
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2014
Participating Start Date
4/1/2014
Participating Approval Date
2/24/2014
Last Recertification Date
2/9/2021
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Jane Pauley Community Health Center
Dale Marion, 340B Program Manager
(317) 552-0690
Primary Contact
Jane Pauley CHC
Michael Dale, CFO
(317) 934-0751
Addresses
Street Address
5259 David St
Indianapolis, IN 46226-1793
Billing Address
Jane Pauley Community Health Center, Inc.
1503 N. Mitthoeffer Rd.
Indianapolis, IN 46229
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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