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FQHCLA390A Mercy Medical Health Center (Terminated)
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Main Details
Name
Mercy Medical Health Center
Subdivision Name
Mercy Medical Quick Care
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-031119
340B ID
FQHCLA390A
Grant Number
LALCS31662
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2020
Participating Start Date
1/1/2021
Participating Approval Date
11/30/2020
Last Recertification Date
1/31/2022
Termination Date
Termination Reason
10/1/2022
Other
Contacts
Authorizing Official
Mercy Medical Health Center
Kimberly Lynn Brunson, CEO
(318) 259-1100
Primary Contact
Mercy Medical Health Center
Rennata Becks, Office Manager
(318) 259-1100
Addresses
Street Address
4629 Quitman Hwy
Hodge, LA 71247-4300
Billing Address
Mercy Medical Quick Care
P O Box 70
Hodge, LA 71247
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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