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CH09123J LA CLINICA DE LA RAZA, INC. (Terminated)
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Main Details
Name
LA CLINICA DE LA RAZA, INC.
Subdivision Name
LA CLINICA VALLEJO DENTAL
Type
HRSA-Funded Health Center
Site ID
BPS-H80-000392
340B ID
CH09123J
Grant Number
H80CS00631
Additional Details
Current Program Status
Terminated
Registration Date
8/3/2007
Participating Start Date
10/1/2007
Participating Approval Date
8/6/2007
Last Recertification Date
2/3/2021
Termination Date
Termination Reason
4/1/2022
Site closure
Contacts
Authorizing Official
La Clinica de La Raza
Jane Garcia, CEO
(510) 535-4000
Primary Contact
La Clinica de La Raza
Dolly Davar, Pharmacy Director
(510) 535-3382
Addresses
Street Address
2920-A SONOMA BLVD
VALLEJO, CA 94590-3879
Billing Address
LA CLINICA DE LA RAZA
P.O. BOX 22210
OAKLAND, CA 94623
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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6/8/10 UPDATED BILL TO (WAS 1515 FRUITVALE AVE, 94601)
06/08/2010
May 2025
May 2025
week
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