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CHC26514-05 TRIAD ADULT AND PEDIATRIC MEDICINE, INC. (Terminated)
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Main Details
Name
TRIAD ADULT AND PEDIATRIC MEDICINE, INC.
Subdivision Name
TAPM-Clara F. Gunn
Type
HRSA-Funded Health Center
Site ID
BPS-H80-014073
340B ID
CHC26514-05
Grant Number
H80CS26514
Additional Details
Current Program Status
Terminated
Registration Date
10/2/2014
Participating Start Date
1/1/2015
Participating Approval Date
10/9/2014
Last Recertification Date
1/31/2017
Termination Date
Termination Reason
1/1/2018
Site closure
Contacts
Authorizing Official
Triad Adult and Pediatric Medicine
Michelle Lewis, CEO
(336) 355-9715
Primary Contact
Triad Adult and Pediatric Medicine
Danielle Cole, Finance Director
(336) 355-9728
Addresses
Street Address
922 Third Avenue
Reidsville, NC 27320
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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May 2025
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