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FQHCLA324A SUMMIT COMMUNITY CARE CLINIC (Terminated)
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Main Details
Name
SUMMIT COMMUNITY CARE CLINIC
Subdivision Name
Summit Middle School
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-012118
340B ID
FQHCLA324A
Grant Number
LALCS00138
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
7/29/2014
Last Recertification Date
2/19/2015
Termination Date
Termination Reason
10/1/2015
Change of covered entity type
Contacts
Authorizing Official
Sarah E. Vaine, CEO
(970) 668-4049
Primary Contact
Sarah E. Vaine, CEO
(970) 668-4049
Addresses
Street Address
158 School Road
Frisco, CO 80443
Billing Address
Summit Community Care Clinic, Inc.
PO Box 4337
Frisco, CA 80443
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
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