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CH10079C LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC (Active)
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Main Details
Name
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
Subdivision Name
WEST MEDFORD HEALTH CENTER--La Clinica
Type
HRSA-Funded Health Center
Site ID
BPS-H80-003317
340B ID
CH10079C
Grant Number
H80CS00759
Additional Details
Current Program Status
Active
Registration Date
4/1/2004
Participating Start Date
4/1/2004
Participating Approval Date
3/11/2004
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
1307 W Main St
Medford, OR 97501-2936
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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NEW SITE 04/01/2004
08/11/2005
May 2025
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