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CH03170N CENTERVILLE CLINIC INC (Active)
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Main Details
Name
CENTERVILLE CLINIC INC
Subdivision Name
FAIRCHANCE CLINIC
Type
HRSA-Funded Health Center
Site ID
BPS-H80-000396
340B ID
CH03170N
Grant Number
H80CS00705
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
2/20/2025
Contacts
Authorizing Official
Centerville Clinics, Inc
Barry R Niccolai, Executive Director
(724) 632-6801 Ext: 1100
Primary Contact
Centerville Clinics, Inc.
Brenda Workman, Administrative Assistant
(724) 632-6801 Ext: 1100
Addresses
Street Address
93 N Morgantown St
Fairchance, PA 15436-1039
Billing Address
Centerville Clinic Inc
1070 Old National Pike
Fredericktown, PA 15333
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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