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FQHCLA465 GALLUP COMMUNITY HEALTH (Active)
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Main Details
Name
GALLUP COMMUNITY HEALTH
Subdivision Name
Gallup Community Health - 2022
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-038323
340B ID
FQHCLA465
Grant Number
LALCS52988
Additional Details
Current Program Status
Active
Registration Date
4/8/2024
Participating Start Date
7/1/2024
Participating Approval Date
6/3/2024
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Gallup Community Health
Valory Wangler, MD
(206) 861-5767
Primary Contact
Gallup Community Health
Betsy DeVries, Quality Director
(505) 397-5855
Addresses
Street Address
2111 College Dr
Gallup, NM 87301-4804
Billing Address
Gallup Community Health
2111 College Dr
Gallup, NM 87301
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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