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HV00621B AIDS RESOURCE CENTER OF WISCONSIN (Terminated)
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Main Details
Name
AIDS RESOURCE CENTER OF WISCONSIN
Subdivision Name
MADISON OFFICE
Type
Ryan White Part C
340B ID
HV00621B
Grant Number
H76HA00621
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2015
Participating Start Date
4/1/2015
Participating Approval Date
1/23/2015
Last Recertification Date
Time Period the Assistance was Received
Termination Date
Termination Reason
1/1/2016
Loss of qualifying grant/support
Contacts
Authorizing Official
AIDS Resource Center of Wisconsin
Michael Gifford, CEO
(414) 225-1547
Primary Contact
Richard Fons, Vice President of Pharmacy Services
(414) 223-6832
Addresses
Street Address
600 WILLIAMSON STREET
MADISON, WI 53703
Billing Address
AIDS RESOURCE CENTER OF WISCONSIN
820 NORTH PLANKINTON AVENUE
MILWAUKEE, WI 53203
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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