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CH057260D KENOSHA COMMUNITY HEALTH CENTER, INC. (Terminated)
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Main Details
Name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Kenosha Community Health Center Mobile Medical Unit
Type
HRSA-Funded Health Center
Site ID
BPS-H80-030823
340B ID
CH057260D
Grant Number
H80CS00662
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/9/2023
Last Recertification Date
2/15/2024
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Kenosha Community Health Center, Inc.
John Stampfl, Controller
(262) 771-3561
Primary Contact
Kenosha Community Health Center Inc.
Paul Forchette, Risk Manager
(262) 764-3618
Addresses
Street Address
6226 14th Ave
Kenosha, WI 53143-4413
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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May 2025
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