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FQHCLA364 BLACK RIVER HEALTH SERVICES INC (Active)
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Main Details
Name
BLACK RIVER HEALTH SERVICES INC
Subdivision Name
Black River Family Practice
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-021687
340B ID
FQHCLA364
Grant Number
LALCS31614
Additional Details
Current Program Status
Active
Registration Date
3/6/2018
Participating Start Date
4/1/2018
Participating Approval Date
3/7/2018
Last Recertification Date
2/17/2025
Contacts
Authorizing Official
Black River Health Services, Inc.
Lee Ann Amann Amann, CEO
(910) 259-6973 Ext: 200
Primary Contact
Black River Health Services
Janice Chapman McDermott, Pharmacy Manager
(910) 283-5400 Ext: 500
Addresses
Street Address
301 South Campbell Street
Burgaw, NC 28425-5011
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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