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FQHCLA396A SHAWNEE MENTAL HEALTH CENTER INC (Active)
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Main Details
Name
SHAWNEE MENTAL HEALTH CENTER INC
Subdivision Name
Coal Grove Clinic
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-027097
340B ID
FQHCLA396A
Grant Number
LALCS32583
Additional Details
Current Program Status
Active
Registration Date
7/1/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/5/2019
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Shawnee Mental Health Center, Inc.
Cynthia Holstein, CEO
(740) 442-7670
Primary Contact
SHAWNEE MENTAL HEALTH CENTER INC
Timothy L Hall, 340B Coordinator
(740) 354-7702 Ext: 1223
Addresses
Street Address
225 Carlton Davidson Ln
Coal Grove, OH 45638-2924
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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