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CH03074F ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES (Terminated)
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Main Details
Name
ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES
Subdivision Name
PENNINGTON FAMILY HEALTH CLINIC
Type
HRSA-Funded Health Center
Site ID
BPS-H80-004993
340B ID
CH03074F
Grant Number
H80CS00604
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2001
Participating Start Date
4/1/2001
Participating Approval Date
2/6/2004
Last Recertification Date
3/7/2016
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
St Charles Health Council, Inc
MALCOLM PERDUE, CEO
(276) 546-5310
Primary Contact
KAY G. MATLOCK, PROGRAM DEVELOPMENT OFFICER
(276) 546-5310
Addresses
Street Address
127 HEALTH CARE DR.
SUITE 12
PENNINGTON GAP, VA 24277
Billing Address
ST. CHARLES HEALTH COUNCIL/STONE MOUNTAIN HEALTH SERVICES
185 REDWOOD AVE.
SUITE 102
PENNINGTON GAP, VA 24277
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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9/23/10 UPDATED PHYS ADD (WAS PO BOX 70, LCCH MED ARTS #6, SUITE D, PENNINGTON GAP, VA), ADDED BILL-TO ADD
09/23/2010
April 2025
April 2025
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