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CH05084W FAMILY HEALTH CENTER OF MARSHFIELD INC (Terminated)
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Main Details
Name
FAMILY HEALTH CENTER OF MARSHFIELD INC
Subdivision Name
FAMILY HEALTH CENTER/MARSHFIELD CLINIC-PARK FALLS CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001336
340B ID
CH05084W
Grant Number
H80CS00792
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/14/2015
Last Recertification Date
2/3/2021
Termination Date
Termination Reason
7/1/2021
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Family Health Center of Marshfield, Inc.
Greg Nycz, Chief Executive Officer
(715) 387-9137
Primary Contact
Family Health Center of Marshfield, Inc.
Xin W. Ruppel, Pharmacy Manager
(715) 221-8754
Addresses
Street Address
50 Sherry Ave
Park Falls, WI 54552-1467
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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