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FQHCLA423F THE OTIS R BOWEN CENTER FOR HUMAN SERVICES INC (Terminated)
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Main Details
Name
THE OTIS R BOWEN CENTER FOR HUMAN SERVICES INC
Subdivision Name
Bowen Center Marshall
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-037566
340B ID
FQHCLA423F
Grant Number
LALCS40296
Additional Details
Current Program Status
Terminated
Registration Date
1/2/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/11/2024
Last Recertification Date
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Otis R. Bowen Center for Human Services, Inc.
Melissa Knecht, Vice President of Finance
(574) 269-0532
Primary Contact
Otis R. Bowen Center for Human Services, Inc
Alisha Jackson, Director of Healthcare Quality
(765) 624-6789
Addresses
Street Address
990 Illinois St
Plymouth, IN 46563-3623
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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