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CH01006Q Fair Haven Community Health Clinic Inc (Active)
Main Details
Name
Fair Haven Community Health Clinic Inc
Subdivision Name
Shoreline Family Health Care
Type
HRSA-Funded Health Center
Site ID
BPS-H80-024620
340B ID
CH01006Q
Grant Number
H80CS00741
Contacts
Authorizing Official
Fair Haven Community Health Clinic, Inc.
SUZANNE LAGARDE, CEO
(203) 752-5129
Primary Contact
Fair Haven Community Health Clinic
Manan Dave, Compliance Officer
(203) 777-7411 Ext: 5198
Additional Details
Current Program Status
Active
Registration Date
1/27/2020
Participating Start Date
4/1/2020
Participating Approval Date
1/28/2020
Last Recertification Date
2/4/2024
Addresses
Street Address
221 W Main St
Branford, CT 06405-4022
Billing Address
Fair Haven Community Health Clinic, Inc
374 Grand Avenue
New Haven, CT 06513
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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