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FP900371 ST. JOHN'S WELL CHILD AND FAMILY CENTER (Terminated)
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Main Details
Name
ST. JOHN'S WELL CHILD AND FAMILY CENTER
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP900371
Grant Number
FPHPA096061
Additional Details
Current Program Status
Terminated
Registration Date
3/4/2006
Participating Start Date
4/1/2006
Participating Approval Date
3/6/2006
Last Recertification Date
5/5/2021
Termination Date
Termination Reason
7/1/2022
Failure to recertify
Contacts
Authorizing Official
St. John's Community Health
James Mangia, CEO
(323) 541-1600 Ext: 4000
Primary Contact
St. John's Well Child and Family Center
Ernesto Barahona, Chief Development Officer
(323) 541-1600 Ext: 1115
Addresses
Street Address
808 58th Street
LOS ANGELES, CA 90037
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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1/9/12-Updated main address (was 5701 Hoover St, Los Angeles, CA 90037)2/17/10 DELETED MEDICAID# (WAS FHC70764F);
01/09/2012
2/17/10 DELETED MEDICAID# (WAS FHC70764F);
02/17/2010
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