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CHC08752-03 LAKELAND IMMEDIATE CARE CENTER (Terminated)
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Main Details
Name
LAKELAND IMMEDIATE CARE CENTER
Subdivision Name
Ranger Wellness Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-013733
340B ID
CHC08752-03
Grant Number
H80CS08752
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2014
Participating Start Date
1/1/2015
Participating Approval Date
10/10/2014
Last Recertification Date
2/5/2021
Termination Date
Termination Reason
1/1/2022
Site closure
Contacts
Authorizing Official
Cassopolis Family Clinic Network
MARY GEEGAN MIDDLETON, Chief Executive Officer
(269) 445-3874 Ext: 109
Primary Contact
Lakleand Immediate Care Center
Meredith Kujawa, Chief Financial Officer
(269) 445-3874 Ext: 137
Addresses
Street Address
22721 Diamond Cove Road
Cassopolis, MI 49031-9711
Billing Address
Lakeland Immediate Care Center
261 M-62
Cassopolis, MI 49031-1034
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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