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FP919111 Centro de Salud de la Comunidad de San Ysidro, Inc. (Active)
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Main Details
Name
Centro de Salud de la Comunidad de San Ysidro, Inc.
Subdivision Name
San Ysidro Health Otay
Type
Family Planning (Title X only)
340B ID
FP919111
Grant Number
FPHPA096061
Additional Details
Current Program Status
Active
Registration Date
3/22/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/13/2012
Last Recertification Date
5/13/2024
Contacts
Authorizing Official
Centro de Salud de la Comunidad de San Ysidro, Inc.
Brian Wallace, VP of Finance & CFO
(619) 662-4100
Primary Contact
Centro de Salud de la Comunidad de San Ysidro Inc.
Douglas Israel, Director of Contracts
(619) 662-4165
Addresses
Street Address
1637 3rd Avenue
Suites H
Chula Vista, CA 91911
Billing Address
San Ysidro Health Center, Inc.
4004 Beyer Blvd
San Ysidro, CA 92173
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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