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CHC00333-03 LAKE COUNTY PRIMARY CARE (Active)
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Main Details
Name
LAKE COUNTY PRIMARY CARE
Subdivision Name
Obion county Medical Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-031113
340B ID
CHC00333-03
Grant Number
H80CS00333
Additional Details
Current Program Status
Active
Registration Date
10/4/2022
Participating Start Date
1/1/2023
Participating Approval Date
10/4/2022
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
citizens of Lake County for Health care Inc.
GAYANNE WILLIAMS, EXECUTIVE DIRECTOR
(731) 253-6690
Primary Contact
Citizens of Lake County for Health Care Inc
Tammi Deason, finance
(731) 253-6690
Addresses
Street Address
321 W Harper St Bldg
Troy, TN 38260-5653
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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