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CH094890 VENICE FAMILY CLINIC (Active)
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Main Details
Name
VENICE FAMILY CLINIC
Subdivision Name
VENICE FAMILY CLINIC
Type
HRSA-Funded Health Center
Site ID
BPS-H80-000901
340B ID
CH094890
Grant Number
H80CS04217
Additional Details
Current Program Status
Active
Registration Date
10/1/1997
Participating Start Date
10/1/1997
Participating Approval Date
4/7/2005
Last Recertification Date
2/14/2025
Contacts
Authorizing Official
Venice Family Clinic
Mitesh G Popat, CEO
(310) 664-7901
Primary Contact
Venice Family Clinic
Isabela Mihai, Chief Compliance Officer
(415) 870-5955
Addresses
Street Address
604 Rose Ave
Venice, CA 90291-2767
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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May 2025
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