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CHC26601-10 Family Medicine Residency Of Idaho (Terminated)
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Main Details
Name
Family Medicine Residency Of Idaho
Subdivision Name
Temporary Site-Family Medicine Health Center, Mobile Van
Type
HRSA-Funded Health Center
Site ID
BPS-H80-030683
340B ID
CHC26601-10
Grant Number
H80CS26601
Additional Details
Current Program Status
Terminated
Registration Date
6/18/2020
Participating Start Date
6/19/2020
Participating Approval Date
6/19/2020
Last Recertification Date
2/11/2021
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
Family Medicine Residency of Idaho, Inc. (The)
Sabrina Allen, Sr. Director of Pharmacy Services
(208) 514-2500 Ext: 7040
Primary Contact
Family Medicine Residency of Idaho, Inc. (The)
Michelle Robin, Sr. Director, Grant Compliance
(208) 860-7299
Addresses
Street Address
777 N Raymond St
Boise, ID 83704-9251
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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