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CH09152G MOUNTAIN HEALTH & COMMUNITY SERVICES, INC. (Terminated)
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Main Details
Name
MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Subdivision Name
25th Street Family Medicine
Type
HRSA-Funded Health Center
Site ID
BPS-H80-000875
340B ID
CH09152G
Grant Number
H80CS00284
Additional Details
Current Program Status
Terminated
Registration Date
8/21/2007
Participating Start Date
10/1/2007
Participating Approval Date
8/22/2007
Last Recertification Date
2/7/2020
Termination Date
Termination Reason
7/1/2020
Other
Contacts
Authorizing Official
Mountain Health & Community Services, Inc
Amy Weisiger, CFO
(619) 478-5254 Ext: 229
Primary Contact
Mountain Health and Community Services, Inc.
Maria Ramirez, Credentialing Coordinator
(619) 478-5254 Ext: 238
Addresses
Street Address
316 25th St
San Diego, CA 92102-3016
Billing Address
MOUNTAIN HEALTH & COMMUNITY SERVICES
31115 HIGHWAY 94
CAMPO, CA 91906
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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