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FQHCLA451 BLACK CANYON COMMUNITY HEALTH CENTER (Terminated)
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Main Details
Name
BLACK CANYON COMMUNITY HEALTH CENTER
Subdivision Name
Black Canyon Community Health Center
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-035166
340B ID
FQHCLA451
Grant Number
LALCS46121
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2023
Participating Start Date
10/1/2023
Participating Approval Date
9/7/2023
Last Recertification Date
2/12/2024
Termination Date
Termination Reason
4/1/2025
Failure to recertify
Contacts
Authorizing Official
Black Canyon Community Health Center Inc.
Rachael Nadado, Chief Operating Officer
(623) 374-0200 Ext: 19
Primary Contact
Black Canyon Community Health Center Inc.
BettyJane Reymer, Manager
(623) 374-0200 Ext: 19
Addresses
Street Address
19251 E Oasis Dr
Black Canyon City, AZ 85324-0000
Billing Address
Black Canyon Community Health Center Inc.
PO Box 1958
Black Canyon City, AZ 85324
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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