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CH10079AK LA CLINCA DEL VALLE FAMILY HEALTH CENTER INC (Active)
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Main Details
Name
LA CLINCA DEL VALLE FAMILY HEALTH CENTER INC
Subdivision Name
La Clinica Acute Care Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-038877
340B ID
CH10079AK
Grant Number
H80CS00759
Additional Details
Current Program Status
Active
Registration Date
10/7/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/10/2024
Last Recertification Date
2/12/2025
Contacts
Authorizing Official
La Clinica del Valle
Traci Fossen, Chief Quality Officer
(541) 512-3912
Primary Contact
La Clinica del Valle
Sochil Castillo, Compliance Coordinator
(541) 512-3127
Addresses
Street Address
638 Market St
Medford, OR 97504-6126
Billing Address
La Clinica Del Valle Family Health Care Center Inc.
931 Chevy Way
Medford, OR 97504
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
June 2025
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