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CH03126E Southbridge Medical Advisory Council Inc (Terminated)
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Main Details
Name
Southbridge Medical Advisory Council Inc
Subdivision Name
HJMC Family Practice
Type
HRSA-Funded Health Center
Site ID
BPS-H80-021468
340B ID
CH03126E
Grant Number
H80CS00385
Additional Details
Current Program Status
Terminated
Registration Date
2/12/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/13/2018
Last Recertification Date
2/27/2019
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center
Shay Scott, CEO
(302) 655-6187 Ext: 230
Primary Contact
Southbridge Medical Advisory Council dba Henrietta Johnson Medical Center
Yvette Gbemudu, CMO
(302) 655-6187 Ext: 233
Addresses
Street Address
1100 S Broom St
Wilmington, DE 19805-4585
Billing Address
Henrietta Johnson Medical Center
601 New Castle Avenue
Wilmington, DE 19801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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