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CHC24098-05 SOUTHERN ILLINOIS UNIVERSITY (Active)
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Main Details
Name
SOUTHERN ILLINOIS UNIVERSITY
Subdivision Name
SIU Center for Family Medicine-Decatur
Type
HRSA-Funded Health Center
Site ID
BPS-H80-019741
340B ID
CHC24098-05
Grant Number
H80CS24098
Additional Details
Current Program Status
Active
Registration Date
10/10/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/20/2017
Last Recertification Date
2/11/2025
Contacts
Authorizing Official
SIU Center for Family Medicine
Iris Elenora Wesley, CEO
(217) 757-8116
Primary Contact
SIU Center for Family Medicine
Michael Black, CFO
(217) 747-6470
Addresses
Street Address
102 West Kenwood Avenue
Decatur, IL 62526
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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