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CHC24098-09 SOUTHERN ILLINOIS UNIVERSITY (Active)
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Main Details
Name
SOUTHERN ILLINOIS UNIVERSITY
Subdivision Name
SIU Center for Family Medicine-Transitions of Western Illinois
Type
HRSA-Funded Health Center
Site ID
BPS-H80-021483
340B ID
CHC24098-09
Grant Number
H80CS24098
Additional Details
Current Program Status
Active
Registration Date
4/12/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/13/2018
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
4409 Maine St, Suite 100
Quincy, IL 62305
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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