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CH05711G 3RD STREET COMMUNITY CLINIC (Terminated)
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Main Details
Name
3RD STREET COMMUNITY CLINIC
Subdivision Name
Shelby OB/GYN - Mobile
Type
HRSA-Funded Health Center
Site ID
BPS-H80-017816
340B ID
CH05711G
Grant Number
H80CS00581
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2016
Participating Start Date
10/1/2016
Participating Approval Date
7/29/2016
Last Recertification Date
2/9/2017
Termination Date
Termination Reason
4/1/2018
Site closure
Contacts
Authorizing Official
Third Street Family Health Services
Brett Toward, Interim CEO
(419) 526-7880
Primary Contact
Third Street Community Clinic
Mary Heflin, Director of Population Health
(419) 526-7879
Addresses
Street Address
600 W Third St
Mansfield, OH 44906-4490
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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