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CH051490 NORTHERN HEALTH CENTERS, INC. (Terminated)
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Main Details
Name
NORTHERN HEALTH CENTERS, INC.
Subdivision Name
DBA NORTHERN HEALTH CENTERS, INC.
Type
HRSA-Funded Health Center
Site ID
BPS-H80-004792
340B ID
CH051490
Grant Number
H80CS00491
Additional Details
Current Program Status
Terminated
Registration Date
1/1/1999
Participating Start Date
1/1/1999
Participating Approval Date
10/6/2004
Last Recertification Date
2/12/2018
Termination Date
Termination Reason
4/1/2019
Failure to recertify
Contacts
Authorizing Official
Northern Health Centers, Inc.
Michele White, Executive Director
(715) 276-6321 Ext: 229
Primary Contact
Northern Health Centers, Inc.
Holly Liptack, Chief Financial Officer
(715) 276-6321 Ext: 224
Addresses
Street Address
15397 HWY 32
LAKEWOOD, WI 54138-0179
Billing Address
Northern Health Centers, Inc.
P.O. Box 179
Lakewood, WI 54138
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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NEW CONTACT INFO, MODIFIED ENTITY NAME
04/12/2011
April 2025
April 2025
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