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CH01006T FAIR HAVEN COMMUNITY HEALTH CLINIC, INC. (Active)
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Main Details
Name
FAIR HAVEN COMMUNITY HEALTH CLINIC, INC.
Subdivision Name
Leeway House
Type
HRSA-Funded Health Center
Site ID
BPS-H80-036650
340B ID
CH01006T
Grant Number
H80CS00741
Additional Details
Current Program Status
Active
Registration Date
8/29/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/30/2023
Last Recertification Date
2/15/2025
Contacts
Authorizing Official
Fair Haven Community Health Clinic, Inc.
SUZANNE LAGARDE, CEO
(203) 752-5129
Primary Contact
Fair Haven Community Health Clinic
Manan Dave, Compliance Officer
(203) 777-7411 Ext: 5198
Addresses
Street Address
40 Albert Street RM MC 1
New Haven, CT 06511
Billing Address
Fair Haven Community Health Clinic, Inc.
374 Grand Ave
New Haven, CT 06513
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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