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RWI39 CHW-CARE PROGRAM AND CLINICS (Terminated)
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Main Details
Name
CHW-CARE PROGRAM AND CLINICS
Subdivision Name
ST. MARY MEDICAL CENTER
Type
Ryan White Part A
340B ID
RWI39
Grant Number
LOS ANGELES EMA / H89HA00016
Additional Details
Current Program Status
Terminated
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
6/7/2005
Last Recertification Date
2/10/2017
Time Period the Assistance was Received
Termination Date
Termination Reason
4/1/2018
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Dignity Health dba St Mary Medical Center
Leon Choiniere, Vice President/Chief Financial Officer
(562) 491-9191
Primary Contact
St Mary Medical Center
Po Ying Fung, Ambulatory Care Pharmacy Coordinator
(562) 491-9598
Addresses
Street Address
1043 ELM AVENUE
SUITE 300
LONG BEACH, CA 90813
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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6/1/09 ADDED MEDICAID#; 5/2006 UPDATED 340B_ID, FORMERLY RW39
08/13/2010
April 2025
April 2025
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