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CHC33649-02 INNER CITY MUSLIM ACTION NETWORK (Terminated)
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Main Details
Name
INNER CITY MUSLIM ACTION NETWORK
Subdivision Name
IMAN-Oral Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-029617
340B ID
CHC33649-02
Grant Number
H80CS33649
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2020
Participating Start Date
7/1/2020
Participating Approval Date
6/11/2020
Last Recertification Date
2/8/2022
Termination Date
Termination Reason
4/1/2023
Site closure
Contacts
Authorizing Official
Inner-city Muslim Action Network
Sofia Adawy, Senior Health Center Director
(773) 434-4626
Primary Contact
Inner-city Muslim Action Network
Maysoon Haleem, Director of Revenue Cycle
(773) 464-4626
Addresses
Street Address
2744 W. 63rd St., Building #2
Chicago, IL 60629
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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