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CH052760 CRUSADERS CENTRAL CLINIC ASSOCIATION (Active)
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Main Details
Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Crusader Clinic on West State Street
Type
HRSA-Funded Health Center
Site ID
BPS-H80-000626
340B ID
CH052760
Grant Number
H80CS00113
Additional Details
Current Program Status
Active
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
3/12/2004
Last Recertification Date
2/18/2025
Contacts
Authorizing Official
Crusader Community Health
Samuel Miller, President/CEO
(815) 490-1600
Primary Contact
Crusaders Central Clinic Association
Millard Washington, 340B Program Manager
(815) 490-1418
Addresses
Street Address
1200 W State St
Rockford, IL 61102-2112
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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6/18/09 SUB DIV NEAM CHANGE (WAS CRUSADERS CLINIC - WEST END PHARMACY) NEW CONTACT, ENTITY NAME CORRECTION
01/24/2011
May 2025
May 2025
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