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CHC22690-02 MACOUPIN, COUNTY OF (Active)
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Main Details
Name
MACOUPIN, COUNTY OF
Subdivision Name
Columbian Boulevard Dental Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-031653
340B ID
CHC22690-02
Grant Number
H80CS22690
Additional Details
Current Program Status
Active
Registration Date
4/1/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/9/2021
Last Recertification Date
2/18/2025
Contacts
Authorizing Official
Macopupin County Public Health Department
Lori J Sanson, CFO
(217) 930-2282
Primary Contact
Macoupin County Public Health Dep
Christy Blank, Chief Executive Officer
(217) 930-2283
Addresses
Street Address
125 W Columbian Blvd S
Litchfield, IL 62056-3021
Billing Address
Macoupin County Public Health Department
205 Oakland Ave
Carlinville, IL 62626
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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