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CH04327AD EAU CLAIRE COOPERATIVE HEALTH CENTER (Terminated)
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Main Details
Name
EAU CLAIRE COOPERATIVE HEALTH CENTER
Subdivision Name
Lake Monticello Family Practice @ McCrorey-Liston
Type
HRSA-Funded Health Center
Site ID
BPS-H80-013771
340B ID
CH04327AD
Grant Number
H80CS00730
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2014
Participating Start Date
1/1/2015
Participating Approval Date
10/22/2014
Last Recertification Date
2/5/2024
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Eau Calire Cooperative Health Center, Inc
DELGADO CANTAVE, CEO
(803) 733-5969 Ext: 4146
Primary Contact
Eau Claire Cooperative Health Center, Inc
GRETCHEN BECKHAM, DIRECTOR OF PHARMACY
(803) 603-5737
Addresses
Street Address
1978 STATE HIGHWAY 215 S
BLAIR, SC 29015-9443
Billing Address
Eau Claire Cooperative Health Center, Inc
PO BOX 3788
Columbia, SC 29230
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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