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FQ61 UPHAM'S CORNER HEALTH CENTER (Terminated)
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Main Details
Name
UPHAM'S CORNER HEALTH CENTER
Subdivision Name
UPHAM'S CORNER HEALTH COMMITTEE
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-009716
340B ID
FQ61
Grant Number
LALCS00010
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2002
Participating Start Date
4/1/2002
Participating Approval Date
4/1/2002
Last Recertification Date
2/25/2015
Termination Date
Termination Reason
1/1/2016
Change of covered entity type
Contacts
Authorizing Official
Edward Grimes, CEO
(617) 287-8000 Ext: 8131
Primary Contact
Edward Grimes, CEO
(617) 287-8000 Ext: 8131
Addresses
Street Address
500 COLUMBIA ROAD
DORCHESTER, MA 02125
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
June 2025
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