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CHC08752-04 LAKELAND IMMEDIATE CARE CENTER (Active)
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Main Details
Name
LAKELAND IMMEDIATE CARE CENTER
Subdivision Name
Niles Community Health Center Dental Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-018673
340B ID
CHC08752-04
Grant Number
H80CS08752
Additional Details
Current Program Status
Active
Registration Date
1/3/2017
Participating Start Date
4/1/2017
Participating Approval Date
1/6/2017
Last Recertification Date
2/18/2025
Contacts
Authorizing Official
Cassopolis Family Clinic Network
Joseph Gavan, Chief Executive Officer
(269) 445-3874
Primary Contact
Niles Community Health Center Pharmacy
Kevin Klipowicz, Pharmacy Director
(269) 665-8900
Addresses
Street Address
122 Grant Street
Niles, MI 49120-2281
Billing Address
Lakeland Immediate Care Center
261 M-62
Cassopolis, MI 49031
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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