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CH10252B COUNTRY DOCTOR COMMUNITY CLINIC (Terminated)
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Main Details
Name
COUNTRY DOCTOR COMMUNITY CLINIC
Subdivision Name
CDCHC After Hours Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-013411
340B ID
CH10252B
Grant Number
H80CS00647
Additional Details
Current Program Status
Terminated
Registration Date
4/5/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/12/2016
Last Recertification Date
2/14/2020
Termination Date
Termination Reason
4/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Country Doctor Community Health Centers
Raleigh R Watts, Executive Director
(206) 299-1628
Primary Contact
Country Doctor Community Clinic
Bessie Chi, Director of Pharmacy
(206) 709-7116
Addresses
Street Address
550 16th Ave STE 100
Seattle, WA 98122-5636
Billing Address
Country Doctor Community Clinic
2101 East Yesler Way
Seattle, WA 98122
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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