340B Drug Pricing Program Database
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CH05302AB West Side Community Health Services, Inc. (Terminated)
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Main Details
Name
West Side Community Health Services, Inc.
Subdivision Name
MN Community Care-Farmington Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-033698
340B ID
CH05302AB
Grant Number
H80CS00790
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2022
Participating Start Date
1/14/2022
Participating Approval Date
1/14/2022
Last Recertification Date
2/1/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
West Side Community Health Services
Reuben Moore, President and Executive Officer
(651) 602-7536
Primary Contact
West Side Community Health Services
Kenneth Scott Nelson, Director of Pharmacy
(715) 566-0729
Addresses
Street Address
19685 Pilot Knob Rd Ste 100
Farmington, MN 55024-7238
Billing Address
West Side Community Health Services
153 Cesar Chavez St.
Attn Pharmacy Department
St. Paul, MN 55107
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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