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CH09100A NORTHEAST VALLEY HEALTH CORPORATION (Active)
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Main Details
Name
NORTHEAST VALLEY HEALTH CORPORATION
Subdivision Name
PACOIMA HEALTH CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001207
340B ID
CH09100A
Grant Number
H80CS00139
Additional Details
Current Program Status
Active
Registration Date
10/1/1997
Participating Start Date
10/1/1997
Participating Approval Date
3/26/2005
Last Recertification Date
2/11/2025
Contacts
Authorizing Official
Northeast Valley Health Corporation
Kimberly Wyard, Chief Executive Officer
(818) 898-1388 Ext: 41620
Primary Contact
Northeast Valley Health Corporation
Artashes R Khachatryan, Pharmacy Director/Primary Contact
(818) 365-8086 Ext: 50205
Addresses
Street Address
12756 Van Nuys Blvd
Pacoima, CA 91331-1626
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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1-24-13 UPDATED to remove billing to Medicaid; Used to be a pharmacy site (did Medicaid billing for drugs but now it is just a dispensary site). Closed the pharmacy at this location several years ago. It is now a CHC site and a Title X site under the parent organization. 3/8/12-Revised Medicaid no. (was PHA412970 CA)
01/24/2013
3/8/12-Revised Medicaid no. (was PHA412970 CA)
03/08/2012
April 2025
April 2025
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