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FQHCLA018A SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER (Terminated)
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Main Details
Name
SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER
Subdivision Name
THE HEALTH AND OPPORTUNITY CENTER
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-017349
340B ID
FQHCLA018A
Grant Number
LALCS00022
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2001
Participating Start Date
7/1/2001
Participating Approval Date
3/4/2005
Last Recertification Date
2/4/2019
Termination Date
Termination Reason
7/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER
Mark Freeland, Executive Director
(618) 482-7922 Ext: 601
Primary Contact
SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER
Tameshia Smith, Billing Coordinator
(618) 874-3120 Ext: 615
Addresses
Street Address
1736 KINGSHIGHWAY
WASHINGTON PARK, IL 62204
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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3/4/05 - UPDATED CONTACT INFO
07/01/2001
May 2025
May 2025
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