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CHC28358-00 POWELL HEALTH CARE COALITION (Terminated)
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Main Details
Name
POWELL HEALTH CARE COALITION
Subdivision Name
Heritage Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-015003
340B ID
CHC28358-00
Grant Number
H80CS28358
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/15/2016
Last Recertification Date
2/24/2022
Termination Date
Termination Reason
4/1/2023
Other
Contacts
Authorizing Official
Powell Health Care Coalition
Colette Rene Mild, Chief Executive Officer
(307) 764-1601
Primary Contact
Powell Health Care Coalition
Julie Mann, Primary Contact
(307) 764-1602
Addresses
Street Address
128 N BENT ST
POWELL, WY 82435-2712
Billing Address
Powell Health Care Coalition
P.O Box 23
Powell, WY 82435-0023
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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