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FQHCLA375B INNER CITY MUSLIM ACTION NETWORK (Terminated)
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Main Details
Name
INNER CITY MUSLIM ACTION NETWORK
Subdivision Name
IMAN-Main Site
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-021998
340B ID
FQHCLA375B
Grant Number
LALCS31661
Additional Details
Current Program Status
Terminated
Registration Date
8/6/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/27/2018
Last Recertification Date
2/24/2020
Termination Date
Termination Reason
7/1/2020
Loss of qualifying grant/support
Contacts
Authorizing Official
Inner-city Muslim Action Network
Sofia Adawy, Senior Health Center Director
(773) 434-4626
Primary Contact
Inner-city Muslim Action Network
Maysoon Haleem, Director of Revenue Cycle
(773) 464-4626
Addresses
Street Address
2744 W. 63rd St.
Chicago, IL 60629
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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