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CRC's Barry Karlin: America's Methadone King
A Methadone Cash Cow

 CRC is Minting Money With Methadone, But Its Opiate Clincs May Not Play Well on Wall Street

by Ted Jackson

 

img 1About four years ago, Phil Herschman approached Barry Karlin with a deal to buy a group of methadone clinics scattered throughout the country. Ultimately, Karlin teamed up with Herschman and bought the methadone clinics in a transaction that was to set CRC Health Group down a very profitable, yet potentially controversial, path of major expansion into the methadone maintenance business.

Methadone maintenance is disdained by many in the treatment industry as a therapy that simply replaces addiction to one drug for another. And while much of the medical community and government agencies like SAMHSA have been strong supporters of maintenance programs, saying they are highly successful, critics charge that methadone programs are mostly successful at controlling the social costs of opiate addiction, doing little to promote actual recovery from the disease.

Despite the potential for controversy, Barry Karlin, CRC's CEO and founder who built the company into the nation's largest addiction treatment enterprise, has plunged head first into the methadone business. In the process, CRC has become the country's largest dispenser of the drug by far, with 61 clinics scattered across many states.

Controversial Foray

And yet, Karlin may be sensitive to the controversial nature of the methadone forays. In many interviews with Treatment Magazine over nearly two years, he has rarely mentioned his methadone investments, also preferring usually to refer to the business as "opiate" rather than methadone. And Karlin has also seemed to prefer to emphasize the importance of the equally fast growing residential side of CRC's business. [Editor's Note: Immediately following publication of this article CRC stopped breaking out its opiate business altogether in its financial statements and has undergone a number of confusing reporting segment changes that make understanding the company's accounting, as well as making financial comparison's, over time very difficult.] 

But recent filings with the Securities and Exchange Commission reveal that methadone maintenance has for the last several years been a very central mainstay of CRC's operations, although it will be less so in the wake of big treatment acquisitions like Sierra Tucson and Aspen Education. The filings also reveal that methadone is by far the most profitable segment of CRC's now far flung addiction treatment business. From 2003 to 2005, CRC grew its methadone operation by about 130 percent, with annual opiate revenues reaching almost $84 million, which equaled 40 percent of CRC's sales in 2005. However, during the same period, operating profits from the methadone segment soared by 240 percent, suggesting that CRC has been able to bring substantial economy of scale efficiencies to the business. Marketing prowess also comes into play, as 82 percent of clients are private pay, with clinics averaging 428 clients each, twice the industry norm. And the profitability of CRC's methadone business far outstrips that of its residential segment, with operating margins from the opiate division reaching an eyepopping 37 percent in 2005, versus the 26 percent operating margins registered by residential treatment. Despite Karlin's protestation that debt leverage at CRC has been "modest," the company has in fact for years been a very leveraged enterprise, reflecting the desire of big institutional and private equity investors like Credit Suisse, the Ontario Municipal Employees Retirement System and, more recently, Bain Capital, to earn outsize returns.

No doubt the steady cash flows of CRC's very predictable and profitable methadone clinics have been attractive to today's high yield debt investors, who recently bought $200 million of CRC bonds.

Leveraging Methadone

Such high yield bonds are now a fixture of the country's debt scene, but decades ago it was conservative companies like electric utilities that dominated the corporate bond markets. Being as they sold an every day human need like electricity, their steady cash flows were ideal backing for bonds. Also, utilities were monopolies whose sales were thus doubly immune from business cycle fluctuations.

Phil Herschman, who now oversees CRC's methadone operations, says that in most of the markets in which CRC operates clinics there is competition, but other methadone clinic investors point out that, in many markets, clinics operate as monopolies. In this sense, but mostly because they sell an every day human need - which opiates are to an addict - methadone clinics are similar to utilities, and thus ideal for backing debt. In reality, though, methadone may in fact be an even better business for today's highly leveraged finance players, mainly because methadone appears to be far more profitable than electricity. And opiate addicts have proven time and time again that they are willing to go without electricity, or even food, to get the opiates they need, another reason why Barry Karlin may have found the ultimate turbo-charged leveraged investment for his private equity backers.But what plays well in the debt markets, which are little understood and little followed by the general public, might not play so well in the high-profile market for stock IPOs, which Bain Capital is no doubt eyeing as a principal avenue of exit from its CRC investment.

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"Ugly Business"

A former investment banker and very successful entrepreneur in the insurance arena - he founded Alexander Hamilton Life, which, when sold, had $50 billion of policies in force - Keith Owens has also emerged as among the nation's leading players in efforts to build, with his Brookside Institute, a highly medical model of addiction treatment.

 

But during the late 1990s, Owens was principally occupied with an aggressive attempt to build a multistate methadone clinic operation through the purchase of 23 fraud ridden clinics he hoped to turn around. After five years and about $2 million, the effort ultimately got bogged down, but not before Owens learned just about everything there is to know about the methadone business.

One thing that gave him a lot of pause, and was a factor in the deals not panning out, was the fact that Owens ultimately became convinced that his plan to cash out by taking the clinics public might very well never come to fruition. That's because he found significant resistance among potential investors to the idea of investing in a methadone clinic IPO, mainly because the methadone business was perceived as too controversial and unsavory. "Investors were leery. It was not going to be an easy sell,"  Owens says, adding that, overall, methadone can be an "ugly business," and often rife with fraud. Most of the owners of the clinics he was looking to acquire were facing big fines, largely from a common scam where Medicaid and Medicare were billed for counseling services never delivered, with the clinics acting simply as dispensing mills.

Higher Standards

With ownership of the nation's 1,000 methadone clinics widely dispersed - Colonial Management, the next largest player, has just over 50 clinics - there is likely plenty of room for CRC to grow by acquisition without paying big premiums. There is also plenty of room for CRC to bring to the methadone business its quite high standards of conduct and clinical effort, which the company most definitely appears well on its way to doing. One area that CRC has so far had quite a small presence in is the outpatient arena, which won’t be for long. That's because Herschman has been engaged in a grueling regulatory effort recently to license CRC’s methadone clinics so that they will be able to deliver a full range of outpatient care. "We are in the process of vastly expanding the range of services we offer at the clinics,"  says Herschman, adding that the opiate division will henceforth be referred to as CRC's outpatient division. The clinics from now on will be comprehensive treatment centers, offering outpatient detox, traditional IOP and a special IOP track to handle the fast growing demand for specialty methamphetamine care. In October, CRC admitted its first two patients into outpatient treatment at the methadone clinics.

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And CRC also appears to be innovating clinically at the clinics, having instituted a novel Maintenance to Abstinence track, which is a two year program geared toward those who want to get off methadone. Clients are stablized for a year on an appropriate dose of methadone, then brought off the drug over 4 to 6 months, followed by a continuing care period. Overall, the strategy of broadening the scope of the methadone clinics is likely to prove brilliant on a number of levels. Not only does it allow CRC to leverage the facilities to enter a business it has less of a presence in, but it also allows for the leveraging of the company's marketing competence and its enormous penetration into the commercial payor space. Going forward it will be less possible to determine methadone's contribution as it becomes commingled with outpatient, but it seems likely methadone will continue to play a key role in backing CRC's debt fueled growth.

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Crc is a love and hate thing but if you know the game you get what u want
written by Andrew L, April 09, 2016
I transferred in Cali from the other methadone clinics that provide treatment and meetings and Yada Yada at the rate of 375$ a month ...and 675$ or higher now cause this was two years ago but I switched to crc and I thought I made the same mistake but they actually give a fuck you have a life and can't spend 45 mins every week talking about life ....ecspecially at 6 am ...I they transferred my two weeks of doses over to crc and I go once every two weeks and have been for 4 year ...I made the mistake of playing the game and going up and up and caught myself slippin at 200 mg a day slowly over this last year I've made it down to 45 mgs and I go down 10 mg every 2 weeks to a month depending how a feel but if I get anxiety from the drop I take Xanax which thank god crc doesn't test for but it's almost got these liquids cuffs off and in another 3 months I'll be methadone free and off that bullshit for life ...fuck heroin and fuck methadone and I don't abuse the Xanax it's only for the day's close to drops so I don't feel like shit
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The clinic has saved my life...
written by Jack, October 24, 2014
I'm a University student, I have wonderful relationships, I'm clean, I'm happy and enjoying life. If you are going to do methadone treatment you have to be your own advocate just like everything in life. If you do the program right it is wonderful. I tried getting clean from shooting the H and made a year once. Always I went back, but this program has opened up a new life for me. If you are following the program, going to your meetings, paying your bills then it works great.
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CRC Horrible for treatment
written by Spencer, August 28, 2013
As I was reading through this post I am in full swing with Dr Gonzo as about everything that he had wrote about being true about crc. I have been on methadone for 3 years now & recently transferred to crc treatment center in Evansville Indiana I want to say that since the first day there I was treated horrible I was told I didn't have a appointment when in fact I did they took all of my phases over a 3 year process I was getting monthly take homes when I transferred I thought that my take homes came along with my phase but not at this crc clinic they made me start as a brand new patient no take homes at all and it is an hour drive to there alone but yet it is the only methadone clinic in the area so they can do what the hell ever they want to do with people it is so sad that this place is the most horrible methadone clinic that I have ever beeb in and I wish that I knew some place or someone to contact in regards to crc Evansville everyone that works there is some of the rudest people I have ever met in my life if you are thinking of going there I would try to find some other clinic but as I say this is the only one around that area for hundreds of miles so just be ready. But in reality someone higher up with crc needs to see the horrible lines as long as 3 to 4 hours sometimes something has got to be done with the way this place is ran.
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bad investment
written by tracy mcdonald, August 12, 2013
this clinic is bad news being dirty, inside and out,
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treatment CRC GROUP ,,,
written by tracy mcdonald, August 12, 2013
I HAVE GONE TO CRC METHADONE CLINIC, and is all about money not treatment, they do not care about anything or anyone, there clinics are very dirty, inside, and out, they have no professionals there, or mental heath care workers, they were doing medicare fraud at the clinic i was at, and over charging people, this is a very bad business, and a bad investment, seeing problems and a drop in there patients, they no knothing about treatment.
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treatment CRC GROUP ,,,
written by tracy mcdonald, August 12, 2013
I HAVE GONE TO CRC METHADONE CLINIC, and is all about money not treatment, they do not care about anything or anyone, there clinics are very dirty, inside, and out, they have no professionals there, or mental heath care workers, they were doing medicare fraud at the clinic i was at, and over charging people, this is a very bad business, and a bad investment, seeing problems and a drop in there patients, they no knothing about treatment.
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CRC & IT'S "METHADONE PROGRAM" IS SATAN! I SOLD MY SOUL TO THE DEVIL & THE PRICE WAS OUTRAGOUS!!!
written by "Dr." GONZO, April 10, 2013
I need info about getting a Methadone Advocate/Advocates!!! I live in VA, & need help! I've been in "Methadone Maintenance Program" (It's in quotes because there is NO PROGRAM, Docs are HACKS, Nurses are HATEFUL/UNHELPFUL, Consolers are over worked, underpaid, & most are NO HELP! They just want your cash, & make you jump through hoops which makes your LIFE & RECOVERY EVEN HARDER, PERIOD!)for 5 going on 6 YEARS!! I'm so afraid of detoxing & leaving "The Clinic" & relapsing, & going right back like I've watched so many others do... I am handing over $100 A WEEK for less than sub-standard treatment by ALMOST everyone in both "Clinics" that I've been a CUSTOMER AT(NOT A PAIENT)!! To explain how bad myself, friends, and other CUSTOMERS have been treated & abused would takes pages... I mean I go to a "Clinic" that the NURSES & HEAD STAFF were CAUGHT STEALING METHADONE TO SELL (TO OTHER CUSTOMERS) & EMBEZZLING CASH on top of that!!! I've had 7 Different (7!) consolers since starting with CRC! You get to know one, start to feel comfortable & opening up. Then *POOF* there gone(90% of the time it's due to there case load & never ending hours, one of mine has left TWICE first time for case load SECOND time was because she just felt like she wasn't helping anyone because of staff problems, case load, & couldn't stand for the way we are TREATED & LACK OF TREATMENT!) which 1 "Clinic" had ex-users as consolers & had been in our shoes at sometime, THE WAY IT SHOULD BE. We have a "Doctor" that is supposed to show up twice a week at 8am (Tues. & Thurs. Dosing hours: 5:30am - 11:00am)he's usually late, & pretty much just deals with Intakes. He also has his own "Doctor's Office" were he gets people hooked on pain pills, then takes them away, & sends them to the "Clinic"! UUUMMM ANYONE ELSE SEE SOMETHING TERRIBLY WRONG WITH JUST THAT FACT?!?! If you want a program try your family doctor for Subutex or Suboxone/Buprenorphine you don't get hooked on them as easy as Methadone, & Suboxone has a opiate blocker built in. Plus there is more of a uniform detox program associated with Buprenorphine & it doesn't last near as long as Methadone. I'm not a Doctor & don't pretend to be just suggestions. I just don't what to keep seeing people keep going down this horrible road I ended up on! DO ANYTHING TO STAY OUT OF THESE "CLINICS" ESPECIALLY ANY OWNED BY CRC! CRC IS A MONOPOLY IN THE METHADONE CLINIC MARKET, so if they had competitors with better service, staff, & treatment they would have to change there terrible ways! SOMETHINGS GOT TO GIVE, PLEASE HELP SPREAD THE WORD ABOUT CRC I BEG YOU!!! Thank you for listening... I will check this site, I can't leave my info due to further problems... - "Dr." GONZO
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written by JOHN SMITH, February 27, 2013
I live outside of Winston Salem NC and we only have one clinic and it is State owned its bad it treats patients substandard.Winston Is a very large City in NC all cities around Winston has 2 or 3 clinics.I wish that CRC would look into opening a Clinic.
Thanks

PLEASE PLEASE PLEASE
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CRC clinic riverside ca.
written by Jimbo, December 13, 2012
I went to the clinic there to be put on suboxone that I found on the Internet. When I got there, and filled out the 200 page intake procedure , not 200 but a lot when you don't fill we'll, and they told me that I should go on methadone and not suboxone because unless I have not taking any (Norcos for at least 48 hours' which I can't do, that I would go into bad withdraws and become sick. So I left. They said that suboxone cost a lot and would not work for me and to get on a 21 day detox program. I came back after a week and opted to do a 21 day detox on methadone. They start you at 30 and take you to 40 which I was bussed on that amount, and bring you down taking 3 mil a day from you. 21 days was to fast and 40 mils was to much! The next program was 180 day. To long! That place was worse than be hooked on the Norcos . Because I had money, they want you hook on the program. I'm now taking suboxone with a real dr . That place is just as bad as having to go to a dealer. No thanks!!
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Hi
written by Jennifer self, December 12, 2012
I've been on methadone for going on 2 years now and I have been up and Down on my dose. The truth is it's no good... I want someone who can help me get off methadone. I live in Texas I can't drive a million miles away to some resort that claims they can end your addiction forever....been there and done that! I need help! I want off!
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wow!
written by gary grant, September 18, 2012
I was on methadone for 4 years most of the time at A CRC facility in Portland or. I was never put in A detox program I went straight to maintenance. I never gave but A few clean U.A'S I was on benzo's and my dose was 160. they would threaten to lower it for the benzo's but never did. A few people I know didn't survive the methadone clinic. it was 12 A day back then. as long as I paid they didn't give A shit. they would threaten A painful "financial detox" of 5-7 milligrams A day if I didn't give them money on time and would raise it back up slower than they lowered it when I paid. I walked off the clinic at 140 milligrams. I have A lot of clean time. A wife and child. after how sick I was and how much pain extreme pain I was in I would never go back to it. they never once offered me bup. bad bad people who herd in junkies to make A buck off them or there state insurance
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How about buprenorphine?
written by Rock, September 03, 2012
You can expect that CRC, after years of claiming that suboxone (buprenorphine) doesn't work, will now be getting into the business of prescribing and inducing suboxone. Don't get me wrong, that is a big step up from methadone but they won't have the cash cow that they had with methadone. Bup. doesn't require that the user come into the clinic every day or third day. They can receive a month's supply or more. Its advantages over methadone are significant for most people. It doesn't create tolerance, so the clinic doesn't need to increase the dose to keep ahead of the withdrawals. You can't od on bup alone. It relieves the withdrawals completely. It blunts the effects of other opiates like heroin, hydrocodone, oxycodone etc. and best of all, no matter how much you take, you can't get high. And......it is a great pain reliever for 0-6 pain levels. Now why hasn't CRC jumped into this option for their opiate addicted patients. Maybe, because you don't have to be an OTP (opioid treatment program), in order, to prescribe it and you can get it just like you do your other prescriptions at CVS. CRC wants hostages and buprenorphine frees opiate addicts to pursue their recovery, family, joy and career. Watch CRC try to find some way to jump onto this train.
As an outpatient provider who has tried to work with CRC to get their patients down off the 130 mgs. typically prescribed, believe me they don't want to work collaboratively. I read a comment from Gerald Schulman, Board member of CRC about what a wonderful organization they are. If so, why are they so reluctant to create colleaguial relationships with other addiction treatment providers in their home communities. Gerald's a great guy but sometimes you get too close to the forest to see the trees.
Profit has, and should be, the motive for healthcare providers, including addiction treatment. In a fairly regulated market, with all providers playing by the same rules, the best provider will prevail. However, we have a totally unregulated industry with little oversight and no accountability. Thus, the deaths at CRC are just a few of the unnecessary deaths that occur in these para professional "non-medical" detox facilities. Hopefully, a light will be shown on our field and the roaches will crawl away to leave the professionals to find a new way to live life clean and sober.
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written by tr, July 16, 2012
Steven,

Where do you live? That sounds like a real bad clinic.
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I am on methadone / i was a junkie for 5 years
written by Jonathan , July 06, 2012
It really is replacing one drug for another, after awhile you stop getting high off heroin.... you start feeling better....of course an addict is going to chase getting high if it is an option but after awhile you just want to feel ok...and when you want to feel ok you make the leap to methadone...and it get that same dose everyday.... methadone is roughly a 50,000,000,000 business a year in america.... i don't care what you say... i am closer then farther away from that number.... that is grossly out of proportion and not right.... they raise you 5mg's at a time once they get you hooked on methadone as well... they only want to bring you down quickly on methadone when you can't pay... but they want to bump you up 5mg's everyday once you reach 30mgs after you first start.... i have mixed feelings about methadone... i rather be going to the clinic 5 days a week then seeing a drug dealer 7 days a week and stealing from my family.... at least now i am able to have a puppy and pay my rent and hang out with my wife and see my family and go to college and pursue my dreams.... opiate addiction i guess now that i think about it really is a disease to the point its like having aids... if you don't take medicine you are going to die sooner...we are all going to die anyways... at least when we take our methadone we feel good enough to get thru the day...and if you can work the system and get medicaid to pay for it then good... but if you can't... you are kind of fucked and end up working to support your methadone habit just like you would your dope habit.... it's all a vicious circle and its quite frankly shitty no matter how you look at i.... maybe one day when everyone realizes they have an asshole too people won't be such dicks
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written by steven, June 09, 2012
CRC is money hungry and don't care about its patients. ive been a patient for a year and a half and i mentioned quitting they always say im not ready, it will take years. they have raised the price every 6 months it was 13.50 a day to start it is now 15.00 a day. they dont do anything to help. my "counselor" told me she isnt good at at dealing with depression i should get help. really. I am looking at other companies to open in my town. im starting a petition to get competition. and 423 patients is not even close. we have 4200 at one clinic. i pay 105 a week multiply that by 4200. its sad they take advantage, but its america the suckiest country.
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What
written by Sean Anon, March 13, 2012
FYI: As I write this comment, it is 2012. I've attended a CRC-run methadone clinic for 10 years -- covering the period before & after this article was published.

I've been clean & sober for 10 years too, without a single "dirty UA" except the one on my admission day.

I've also been on the highest "step level" at the clinic for all these years.

Yet nobody has ever mentioned a "Maintenance to Abstinence" program or track to me, and nothing of the sort has appeared on any signs or handouts, including the monthly schedule of group therapy meetings.

And while this track or program might sound good to outsiders, the name would offend many (if not most) people receiving methadone maintenance treatment, even though most would probably support the objective of such a program.

So, given the name of this program, and given my own experience at a CRC-run clinic, I cannot help but question whether the "Maintenance to Abstinence" program actually exists in practice.
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research assistant
written by jennifer lee, August 28, 2011
Such an important article and no comments? Well, we need to take a closer look at this. . .

I was always under the impression that clinics were run by humanitarian drug advocates, were paid for by the government and non-profit. I would like to know more, the details of how these really work; I understand it is similar to private prisons, where the government is billed for each prisoner, who, as most know, are often drug addicts.

I've contacted many methadone clinics, and what struck me is how they say nothing at all about heroin addiction; it was all slanted toward curing prescription pain medication "addiction." From the media, it seems they are trying to get away from the stigma of methadone and the junkie.

I know that addicts have to pay around $350/mth for the program; for many, that's more than half their income. So how much does the government pay per person? What are these clinics making? Why do they refuse to dose if the client is short the cash? How it that any different from a dealer who says no cash, no junk?



Clinics should be that--clinics. Not big business. And why methadone instead of suboxone? It's fare less toxic and more effective at preventing craving. Clients tell me it's because suboxone is more expensive and not covered by med-ical, which still the question, why not cover it?

And why is it that doctors cannot treat addiction? It makes the most sense.

Aside from wanting to know more about the business of methadone clinics, I would like to hear from methadone clients and former clients, as well as from addicts who refuse to go to a meth clinic any why. I'd appreciate it if you can put this out there, and give my email for response.

It is not just a curiosity; my ex is a journalist with one of the biggest papers in the country; he says that it is a hardsell because "nobody cares about drug addicts," but if I can get enough interviews for a story , he will bring it to the table.

I would like to hear from everybody, clients, owners, policy makers, experts, truth tellers and liars.

One more thing. . .I was greatly upset by the inundation of cruel remarks after the tragic death of the brilliant Amy Winehouse. Why such harshness toward a fragile and suffering community? Even a great talent cannot escape condemnation?

email \n This e-mail address is being protected from spambots. You need JavaScript enabled to view it '> This e-mail address is being protected from spambots. You need JavaScript enabled to view it or snail mail: 7960B #210 Aptos, CA 95003

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written by d.r. schuler, March 16, 2011
i would just like to say that i have been going to the new river branch of the crc in galax va for over a year and if i hadn't found this place i would probably be dead. christ gave me an angel of salvation here because i was injected ten to twelve oxycontin 80's every day and my life had became unmanageable, i lost my career and my friends as well as my dignity. i don't doubt that these guys make a good bit of cash from this business but at least it is in a controlled environment. i have been clean for a year now! praise be to God!
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CRC Sells Clinic in KC
written by Terry , June 25, 2009
CRC recently sold its methadone clinic in KC, the staff posted notice saying new owners would takeover June 19,2009, that day has since passed. Everything with CRC name on it has been taken down but the patients aren't really being told who owns it now, when the sale first happen a few months back one staff member mentioned the name Merick or Merrick, I ask the nurse on the 20th who the new owners were he also said merrick, he said they were large pharmaceutical company the only thing I have that closely matchs that is MERCK so are they the new owners ? Has it been sold ? The patients have been very unhappy since the CRC takeover patients have left in large numbers some have contacted crc corp. on numerous occasions it's been a nightmare for patients since CRC and I'm sure Kansas City has been a nightmare for CRC as well. So maybe they didn't sell because zero info can be found out about it, maybe change the name tell patiets CRC doesn't own it anymore so patients stop going to corp. on the poor patient services. I don't know but it all seems very weird and people are keeping tight lips. If anyone has info please let me know.
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