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CH01006H FAIR HAVEN COMMUNITY HEALTH CLINIC INC (Terminated)
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Main Details
Name
FAIR HAVEN COMMUNITY HEALTH CLINIC INC
Subdivision Name
"Smiles 2 Go" Dental Van
Type
HRSA-Funded Health Center
Site ID
BPS-H80-013687
340B ID
CH01006H
Grant Number
H80CS00741
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/13/2015
Last Recertification Date
1/30/2019
Termination Date
Termination Reason
4/1/2020
Site closure
Contacts
Authorizing Official
Fair Haven Community Health Clinic, Inc.
SUZANNE LAGARDE, CEO
(203) 752-5129
Primary Contact
Fair Haven Community Health Center
Robyn Hoffmann, Compliance Officer
(203) 752-5198
Addresses
Street Address
374 GRAND AVE
NEW HAVEN, CT 06513-3733
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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