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FQHCLA334X NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (Terminated)
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Main Details
Name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Subdivision Name
Lafayette Houses Child Health Clinic
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-014612
340B ID
FQHCLA334X
Grant Number
LALCS00169
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
4/22/2015
Last Recertification Date
Termination Date
Termination Reason
4/1/2016
Change of covered entity type
Contacts
Authorizing Official
Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479
Primary Contact
Anita Lee, Chief Operating Officier
(718) 960-2632
Addresses
Street Address
434 Dekalb Ave
Brooklyn, NY 11205-4406
Billing Address
Morrisania D&TC
1225 Gerard Ave
Bronx, NY 10452-8001
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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