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CHC26633-02 OWENSVILLE PRIMARY CARE INC (Active)
Main Details
Name
OWENSVILLE PRIMARY CARE INC
Subdivision Name
Bay Community Health - Lothian
Type
HRSA-Funded Health Center
Site ID
BPS-H80-036115
340B ID
CHC26633-02
Grant Number
H80CS26633
Contacts
Authorizing Official
Owensville Primary Care, Inc
Juanita M Tryon, Chief Executive Officer
(443) 607-1438
Primary Contact
Owensville Primary Care, Inc.
Bret Lee Minarik, CFO
(443) 607-1434
Additional Details
Current Program Status
Active
Registration Date
7/4/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/12/2023
Last Recertification Date
1/29/2024
Addresses
Street Address
5408 Southern Maryland Blvd Unit 7
Lothian, MD 20711-2601
Billing Address
Owensville Primary Care
134 Owensville Road
West River, MD 20778
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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