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CH05090A LA CLINICA DE LOS CAMPESINOS INC (Active)
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Main Details
Name
LA CLINICA DE LOS CAMPESINOS INC
Subdivision Name
Noble Community Clinics - Stevens Point Main Street
Type
HRSA-Funded Health Center
Site ID
BPS-H80-035953
340B ID
CH05090A
Grant Number
H80CS00713
Additional Details
Current Program Status
Active
Registration Date
4/4/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/5/2023
Last Recertification Date
2/13/2025
Contacts
Authorizing Official
La Clinica de los Campesinos
Laura Waldvogel, CEO
(920) 787-9406
Primary Contact
La Clinica De Los Campesinos, Inc.
Kellen J Dorff, Director of Pharmacy
(920) 647-8984
Addresses
Street Address
3125 Main Street
Stevens Point, WI 54481
Billing Address
LA CLINICA DE LOS CAMPESINOS INC
PO Box 1440
WAUTOMA, WI 54982
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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