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FQHCLA346 HIGHLAND HEALTH PROVIDERS CORPORATION (Terminated)
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Main Details
Name
HIGHLAND HEALTH PROVIDERS CORPORATION
Subdivision Name
Highland Health Providers
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-018247
340B ID
FQHCLA346
Grant Number
LALCS00180
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/16/2017
Last Recertification Date
2/10/2020
Termination Date
Termination Reason
7/1/2020
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Highland District Hospital
Meghann Ackley, Chief Financial Officer
(937) 840-6617
Primary Contact
Highland Health Providers
Kelsey Cloud, Clinic Manager
(937) 393-8426
Addresses
Street Address
1487 N. High St.
Suite102
Hillsboro, OH 45133-8496
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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