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CH10817L DIRNE HEALTH CENTERS, INC. (Terminated)
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Main Details
Name
DIRNE HEALTH CENTERS, INC.
Subdivision Name
Heritage Health Dental Clinic - Wallace
Type
HRSA-Funded Health Center
Site ID
BPS-H80-014840
340B ID
CH10817L
Grant Number
H80CS02331
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/16/2015
Last Recertification Date
2/8/2017
Termination Date
Termination Reason
4/1/2018
Site closure
Contacts
Authorizing Official
Heritage Health
Michael Baker, CEO
(208) 292-0256
Primary Contact
Dirne Health Centers Inc DBA Heritage Health
Mark Hampe, CFO
(208) 262-0252
Addresses
Street Address
413 PINE ST
WALLACE, ID 83873-2256
Billing Address
Heritage Health
PO BOX 3648
Coeur d'Alene, ID 83816
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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