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CH10766V CENTRAL CITY CONCERN (Terminated)
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Main Details
Name
CENTRAL CITY CONCERN
Subdivision Name
Blackburn Center Recuperative Care Program
Type
HRSA-Funded Health Center
Site ID
BPS-H80-027853
340B ID
CH10766V
Grant Number
H80CS00234
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/3/2023
Last Recertification Date
1/29/2024
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Central City Concern
Andrew Mendenhall, CEO
(503) 294-1681
Primary Contact
Central City Concern
Chris Lagor, Compliance Manager
(971) 361-7769
Addresses
Street Address
12133 E Burnside St
Portland, OR 97216-3737
Billing Address
Central City Concern
232 NW 6th Ave
Portland, OR 97209
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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