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FQHCLA362C Clover Fork Outpatient Medical Project, Inc. (Active)
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Main Details
Name
Clover Fork Outpatient Medical Project, Inc.
Subdivision Name
Clover Fork School Based Health at Black Mountain Elementary
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-027648
340B ID
FQHCLA362C
Grant Number
LALCS31536
Additional Details
Current Program Status
Active
Registration Date
10/1/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/7/2019
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Clover Fork Outpatient Medical Project INC
Jack Miniard, Chief Executive Officer
(606) 837-2108 Ext: 122
Primary Contact
Clover Fork Outpatient Medical Project INC
Linda C Blevins, Chief financial Officer
(606) 837-2108 Ext: 5114
Addresses
Street Address
1555 Highway 215
Evarts, KY 40828-6522
Billing Address
Clover Fork Outpatient Medical Project INC.
101 Chad Street
Box 39
Evarts, KY 40828
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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