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CH03170G CENTERVILLE CLINIC INC (Active)
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Main Details
Name
CENTERVILLE CLINIC INC
Subdivision Name
REPUBLIC MEDICAL AND DENTAL CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-002448
340B ID
CH03170G
Grant Number
H80CS00705
Additional Details
Current Program Status
Active
Registration Date
4/1/1995
Participating Start Date
4/1/1995
Participating Approval Date
1/15/2004
Last Recertification Date
2/20/2025
Contacts
Authorizing Official
Centerville Clinics, Inc
Barry R Niccolai, Executive Director
(724) 632-6801 Ext: 1100
Primary Contact
Centerville Clinics, Inc.
Brenda Workman, Administrative Assistant
(724) 632-6801 Ext: 1100
Addresses
Street Address
1006 MAIN STREET
REPUBLIC, PA 15475
Billing Address
Centerville Clinics Inc
1070 Old National Pike Road
Fredericktown, PA 15333
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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NAME CORRECTION
01/15/2004
April 2025
April 2025
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