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FQHCLA361B Adult And Child Health Inc (Active)
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Main Details
Name
Adult And Child Health Inc
Subdivision Name
Adult and Child Health - Greenwood
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-024896
340B ID
FQHCLA361B
Grant Number
LALCS31537
Additional Details
Current Program Status
Active
Registration Date
11/26/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/26/2018
Last Recertification Date
2/24/2025
Contacts
Authorizing Official
Adult and Child Health
Jessica Stembel, Chief Clinical Officer
(317) 494-0739
Primary Contact
Adult and Child Health
Dhvani Derasari, 340B Program Manager
(682) 559-8205
Addresses
Street Address
8320 Madison Ave
Indianapolis, IN 46227-6066
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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