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CH05004D SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION (Terminated)
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Main Details
Name
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORPORATION
Subdivision Name
MURPHYSBORO HEALTH CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-002679
340B ID
CH05004D
Grant Number
H80CS00667
Additional Details
Current Program Status
Terminated
Registration Date
7/1/1998
Participating Start Date
7/1/1998
Participating Approval Date
9/7/2004
Last Recertification Date
3/3/2016
Termination Date
Termination Reason
10/1/2016
Other
Contacts
Authorizing Official
Shawnee Health Service and Development Corporation
Patsy R. Jensen, CEO
(618) 985-8221
Primary Contact
Shawnee Health Service and Development Corporation
David Smiley, Pharmacist
(618) 684-9362
Addresses
Street Address
7 S Hospital Dr
Murphysboro, IL 62966-3333
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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2/1/13 ***** LOOKS LIKE A DUPLICATE TO CH05004A ***** 3/28/06 - ADDRESS UPDATED (PREVIOUS ADDRESS: UNION-JACKSON FARM LABOR CAMP, 8125 OLD HIGHWAY 51 NORTH, COBDEN IL 62920)
02/01/2013
NEW CONTACT INFO, CORRECTED ENTITY NAME; 3/28/06 - ADDRESS UPDATED (PREVIOUS ADDRESS: UNION-JACKSON FARM LABOR CAMP, 8125 OLD HIGHWAY 51 NORTH, COBDEN IL 62920)
03/28/2006
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