15D2240561 CLIA NUMBER - TERRE HAUTE OUTPATIENT CLINIC

Laboratory Demographics

CLIA Number: 15D2240561

Facility Name: TERRE HAUTE OUTPATIENT CLINIC

Facility Address:
5080 EAST BILL FARR DRIVE
TERRE HAUTE, IN
ZIP 47803
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Facility Phone Number: 317 988-2219

Facility Type: Community Clinic

Certificate Type: Accreditation

NPI Number: 1992475206

Taxonomy: 332100000X - Department of Veterans Affairs (VA) Pharmacy
Department of Veterans Affairs (VA) Pharmacy means any place under VA jurisdiction where drugs are dispensed and Pharmaceutical Care is provided to enrolled Veterans, by licensed pharmacists. The Pharmacy is reviewed by JCAHO, utilizes the VA hospital's DEA number, and has a designated NCPDP number. VA facility pharmacies include Inpatient (Institutional), Outpatient, Consolidated Mail Outpatient Pharmacies (CMOPs), Research, Addiction Treatment Centers, Long Term Care and Community Based Outpatient Clinics Pharmacies. The VHA Pharmacy Benefits Management - Strategic Healthcare Group has oversight for professional and practice activities of VA Pharmacies. Each pharmacy is under the direct supervision of a U.S. or U.S. territory licensed pharmacist, and has staffing to meet its designated scope of service.

CLIA Record

Field Name	Field Value
CLIA Number	15D2240561
LAB Type	Community Clinic
Facility Name	TERRE HAUTE OUTPATIENT CLINIC
Street	5080 EAST BILL FARR DRIVE
City	TERRE HAUTE
State	IN
ZIP	47803
Phone	317 988-2219
CertificateType	1
CertificateEffectiveDate	10/20/2021
CertificateExpirationDate	5/22/2026
FacilityType	Accreditation

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This page was last updated on: 4/23/2024