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FQHCLA364A BLACK RIVER HEALTH SERVICES INC (Active)
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Main Details
Name
BLACK RIVER HEALTH SERVICES INC
Subdivision Name
Black River Health Center
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-021691
340B ID
FQHCLA364A
Grant Number
LALCS31614
Additional Details
Current Program Status
Active
Registration Date
7/2/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/1/2018
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
109 W. Church Street
Atkinson, NC 28425-0000
Billing Address
Black River Health Services, Inc.
301 South Campbell Street
Burgaw, NC 28425-5011
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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