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CH01006J FAIR HAVEN COMMUNITY HEALTH CLINIC INC (Active)
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Main Details
Name
FAIR HAVEN COMMUNITY HEALTH CLINIC INC
Subdivision Name
Fair Haven Community Health Center @ 50 Grand
Type
HRSA-Funded Health Center
Site ID
BPS-H80-014260
340B ID
CH01006J
Grant Number
H80CS00741
Additional Details
Current Program Status
Active
Registration Date
10/13/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/13/2015
Last Recertification Date
2/15/2025
Contacts
Authorizing Official
Fair Haven Community Health Clinic, Inc.
SUZANNE LAGARDE, CEO
(203) 752-5129
Primary Contact
Fair Haven Community Health Clinic
Manan Dave, Compliance Officer
(203) 777-7411 Ext: 5198
Addresses
Street Address
50 GRAND AVE
NEW HAVEN, CT 06513-3949
Billing Address
Fair Haven Community Health Clinic
374 Grand Avenue
New Haven, CT 06513
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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