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CH05276Q CRUSADERS CENTRAL CLINIC ASSOCIATION (Active)
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Main Details
Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Crusader Community Health on Alpine
Type
HRSA-Funded Health Center
Site ID
BPS-H80-017086
340B ID
CH05276Q
Grant Number
H80CS00113
Additional Details
Current Program Status
Active
Registration Date
5/9/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/10/2017
Last Recertification Date
2/23/2025
Contacts
Authorizing Official
Crusader Community Health
Samuel Miller, President/CEO
(815) 490-1600
Primary Contact
Crusaders Central Clinic Association
Millard Washington, 340B Program Manager
(815) 490-1418
Addresses
Street Address
1215 N ALPINE RD
ROCKFORD, IL 61107
Billing Address
Crusaders Central Clinic Association
1200 W State St
Rockford, IL 61102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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May 2025
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