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FQHCLA348 COLLIN COUNTY ADULT CLINIC (Terminated)
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Main Details
Name
COLLIN COUNTY ADULT CLINIC
Subdivision Name
Collin County Adult Clinic
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-013945
340B ID
FQHCLA348
Grant Number
LALCS00156
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/7/2017
Last Recertification Date
3/6/2018
Termination Date
Termination Reason
4/1/2019
Failure to recertify
Contacts
Authorizing Official
Collin County Adult Clinic
Patricia Sumler, Executive Director
(972) 423-4944
Primary Contact
Collin County Adult Clinic
Van le, Coordinator
(972) 423-4941
Addresses
Street Address
2520 K Ave STE 100
Plano, TX 75074-5342
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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