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CH09108BM CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC. (Active)
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Main Details
Name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Subdivision Name
San Ysidro Health Senior Dental Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-037110
340B ID
CH09108BM
Grant Number
H80CS10748
Additional Details
Current Program Status
Active
Registration Date
4/8/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/30/2024
Last Recertification Date
2/24/2025
Contacts
Authorizing Official
Centro de Salud de la Comunidad de San Ysidro, Inc.
Brian Wallace, VP of Finance & CFO
(619) 662-4100
Primary Contact
Centro de Salud de la Comunidad de San Ysidro Inc.
Douglas Israel, Director of Contracts
(619) 662-4165
Addresses
Street Address
1525 Fourth Ave STE 201
San Diego, CA 92101-3107
Billing Address
San Ysidro Health San Ysidro Health Center
4004 Beyer Blvd
San Ysidro, CA 92173
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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