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CH05744Q PCC COMMUNITY WELLNESS CENTER (Terminated)
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Main Details
Name
PCC COMMUNITY WELLNESS CENTER
Subdivision Name
PCC at Healthcare Alternative Systems, Inc.
Type
HRSA-Funded Health Center
Site ID
BPS-H80-028370
340B ID
CH05744Q
Grant Number
H80CS00276
Additional Details
Current Program Status
Terminated
Registration Date
4/7/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/22/2020
Last Recertification Date
2/4/2022
Termination Date
Termination Reason
4/1/2023
Site closure
Contacts
Authorizing Official
PCC Community Wellness Center
Toni Bush, President and CEO
(708) 524-7678
Primary Contact
PCC Community Wellness Center
Patrick R Garrick, Chief Financial Officer
(708) 383-0113 Ext: 7340
Addresses
Street Address
4534 S. Western Ave
Chicago, IL 60609-3027
Billing Address
PCC Community Wellness Center
14 Lake Street
Oak Park, IL 60302
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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