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CH081150N Coal Country Community Health Center (Terminated)
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Main Details
Name
Coal Country Community Health Center
Subdivision Name
Coal Country Community Health Center - Killdeer High School Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-036478
340B ID
CH081150N
Grant Number
H80CS09469
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/5/2023
Last Recertification Date
2/9/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Coal Country Community Health Center
Kurt V Waldbillig, CEO
(701) 873-6008
Primary Contact
Coal Country Community Health Center
Brooke G Borlaug, Clinic Director
(701) 873-7411
Addresses
Street Address
1415 High St NW
Killdeer, ND 58640
Billing Address
Coal Country Community Health Center
1312 Highway 49 N
Beulah, ND 58523
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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