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CH057260G KENOSHA COMMUNITY HEALTH CENTER, INC. (Active)
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Main Details
Name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Kenosha Community Health Center, Inc.
Type
HRSA-Funded Health Center
Site ID
BPS-H80-018344
340B ID
CH057260G
Grant Number
H80CS00662
Additional Details
Current Program Status
Active
Registration Date
1/5/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/9/2023
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Kenosha Community Health Center, Inc.
John Stampfl, Controller
(262) 771-3561
Primary Contact
Kenosha Community Health Center, Inc.
Mark P. Celebre, Director of Pharmacy
(262) 771-1920
Addresses
Street Address
903 S 2nd St
Silver Lake, WI 53170-1747
Billing Address
Kenosha Community Health Center
4006 Washington Road
Kenosha, WI 53144
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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