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CH06301N LA CLINICA DE FAMILIA, INC (Terminated)
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Main Details
Name
LA CLINICA DE FAMILIA, INC
Subdivision Name
EAST MESA DENTAL CLINIC
Type
HRSA-Funded Health Center
Site ID
BPS-H80-005627
340B ID
CH06301N
Grant Number
H80CS00316
Additional Details
Current Program Status
Terminated
Registration Date
3/4/2009
Participating Start Date
4/1/2009
Participating Approval Date
3/5/2009
Last Recertification Date
2/26/2018
Termination Date
Termination Reason
4/1/2018
Other
Contacts
Authorizing Official
La Clinica de Familia, Inc.
Virgil Medina, CEO
(575) 526-1105
Primary Contact
La Clinica de Familia, Inc.
Olivia Martinez, Accounting Manager
(575) 526-1105
Addresses
Street Address
8600 BATAAN MEMORIAL E
LAS CRUCES, NM 88011
Billing Address
LA CLINICA DE FAMILIA, INC., ADMINISTRATION
385 Calle de Alegra
Bldg. A
LAS CRUCES, NM 88005
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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3/7/12-Changed Authorizing Official (was HARRIET BRANDSTETTER)
03/07/2012
June 2025
June 2025
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