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FQHCLA81B NORTHEAST COMMUNITY CLINIC, INC (Active)
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Main Details
Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic - Community Medical Alliance
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-009874
340B ID
FQHCLA81B
Grant Number
LALCS00033
Additional Details
Current Program Status
Active
Registration Date
4/1/2005
Participating Start Date
4/1/2011
Participating Approval Date
3/31/2011
Last Recertification Date
3/4/2025
Contacts
Authorizing Official
Northeast Community Clinic
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Primary Contact
Northeast Community Clinic
Emely Orozco, Pharmacy Program Administrator
(626) 457-5209
Addresses
Street Address
4129 E Gage Ave
Bell, CA 90201
Billing Address
NORTHEAST COMMUNITY CLINIC
2550 W MAIN STREET, SUITE 301
ALHAMBRA, CA 91801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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3/31/11 PARTICIPATING 4/1/05-12/31/09, PARTICIPATION TERMINATED (IN ERROR) 1/1/10-3/31/11
04/01/2005
April 2025
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