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FQHCLA81F NORTHEAST COMMUNITY CLINIC, INC (Terminated)
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Main Details
Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic - California Family Care
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-009877
340B ID
FQHCLA81F
Grant Number
LALCS00033
Additional Details
Current Program Status
Terminated
Registration Date
5/31/2007
Participating Start Date
4/1/2011
Participating Approval Date
3/31/2011
Last Recertification Date
2/21/2019
Termination Date
Termination Reason
7/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Northeast Community Clinic
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Primary Contact
Northeast Community Clinic
Estefania Pulido Verduzco, Executive Assistant
(626) 457-6900
Addresses
Street Address
1414 Grand Avenue STE 200
Los Angeles, CA 90015-3072
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 7/1/07-12/31/09, PARTICIPATION TERMINATED (IN ERROR) 1/1/10-3/31/11
05/31/2007
May 2025
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