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CH09100AA Northeast Valley Health Corporation (Active)
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Main Details
Name
Northeast Valley Health Corporation
Subdivision Name
Maclay Wellness Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-003235
340B ID
CH09100AA
Grant Number
H80CS00139
Additional Details
Current Program Status
Active
Registration Date
10/9/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/16/2020
Last Recertification Date
2/11/2025
Contacts
Authorizing Official
Northeast Valley Health Corporation
Kimberly Wyard, Chief Executive Officer
(818) 898-1388 Ext: 41620
Primary Contact
Northeast Valley Health Corporation
Artashes R Khachatryan, Pharmacy Director/Primary Contact
(818) 365-8086 Ext: 50205
Addresses
Street Address
12451 W. Gain Street
Pacoima, CA 91331-1642
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Participated starting 7/1/2007, terminated 1/1/2019. Reinstated 1/1/2021.
10/14/2020
June 2025
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