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CH09312BW FAMILY HEALTH CENTERS OF SAN DIEGO, INC. (Terminated)
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Main Details
Name
FAMILY HEALTH CENTERS OF SAN DIEGO, INC.
Subdivision Name
Teen Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-007176
340B ID
CH09312BW
Grant Number
H80CS00224
Additional Details
Current Program Status
Terminated
Registration Date
10/19/2010
Participating Start Date
1/1/2011
Participating Approval Date
11/22/2010
Last Recertification Date
2/18/2019
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Family Health Centers of San Diego
Ricardo Roman, CFO
(619) 906-4603
Primary Contact
Family Health Centers of San Diego
Jenna Harris, Business Analysis and Compliance Manager
(619) 215-2300 Ext: 4438
Addresses
Street Address
1643 Logan Ave
San Diego, CA 92113-1004
Billing Address
Family Health Centers
823 Gateway Centerway
San Diego, CA 92102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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