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CHC26568-01 SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER (Active)
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Main Details
Name
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER
Subdivision Name
Regional Health Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-013303
340B ID
CHC26568-01
Grant Number
H80CS26568
Additional Details
Current Program Status
Active
Registration Date
4/4/2014
Participating Start Date
7/1/2014
Participating Approval Date
4/15/2014
Last Recertification Date
2/24/2025
Contacts
Authorizing Official
Southlake Community Mental Health Center, Inc
Amy Lopez, Executive Director
(219) 671-6047
Primary Contact
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER
Lori Bugielski, Pharmacy Tech/analyst
(219) 840-2694
Addresses
Street Address
559 State St
Hammond, IN 46320-1533
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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