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CHC24152-01 LAKESHORE COMMUNITY HEALTH CARE, INC (Terminated)
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Main Details
Name
LAKESHORE COMMUNITY HEALTH CARE, INC
Subdivision Name
Lakeshore Community Health Care, Inc. - Manitowoc
Type
HRSA-Funded Health Center
Site ID
BPS-H80-014186
340B ID
CHC24152-01
Grant Number
H80CS24152
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/10/2015
Last Recertification Date
2/14/2017
Termination Date
Termination Reason
4/1/2018
Other
Contacts
Authorizing Official
Lakeshore Community Health Care
Kristin Blanchard Stearns, CEO
(920) 783-6633 Ext: 204
Primary Contact
Lakeshore Community Health Care
Christa Wilson, Director of Pharmacy
(920) 783-6633 Ext: 255
Addresses
Street Address
601 BUFFALO ST
MANITOWOC, WI 54220-6817
Billing Address
Lakeshore Community Health Care, Inc.
PO Box 959
Sheboygan, WI 53082-0959
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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