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CH052090 MILWAUKEE HEALTH SERVICES, INC. (Active)
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Main Details
Name
MILWAUKEE HEALTH SERVICES, INC.
Subdivision Name
MILWAUKEE HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001430
340B ID
CH052090
Grant Number
H80CS00826
Additional Details
Current Program Status
Active
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
1/21/2010
Last Recertification Date
2/14/2025
Contacts
Authorizing Official
MHSI
Tito Izard, President/CEO
(414) 267-2021
Primary Contact
Milwaukee Health Services, Inc.
Michele LeBourgeois, Chief Operating Officer
(414) 267-2026
Addresses
Street Address
2555 N Dr Martin Luther King Dr
Milwaukee, WI 53212-2709
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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7/22/07 UPDATED SUBDIV NAME (WAS ISAAC COGGS HEALTH CONNECTION, INC); 7/22/07 UPDATED ADDR(WAS 2770 NORTH FIFTH ST., ZIP 53206); 7/22/07 UPDATED MEDICAID # (WAS 33192600)
01/21/2010
April 2025
April 2025
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