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FQHCLA391A 219 Health Network, Inc. (Terminated)
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Main Details
Name
219 Health Network, Inc.
Subdivision Name
219 Health Network
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-027583
340B ID
FQHCLA391A
Grant Number
LALCS32751
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/10/2019
Last Recertification Date
Termination Date
Termination Reason
4/1/2020
Site closure
Contacts
Authorizing Official
219 Health Network, Inc.
Ibrahim Mohammed Najamuddin, Executive Director
(219) 703-2585
Primary Contact
219 Health Network, Inc.
Shawnta Benitez, Clinical Operations Manager
(219) 703-2583
Addresses
Street Address
525 W Chicago Ave
East Chicago, IN 46312-3206
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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