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CH091230 LA CLINICA DE LA RAZA, INC. (Active)
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Main Details
Name
LA CLINICA DE LA RAZA, INC.
Subdivision Name
Type
HRSA-Funded Health Center
Site ID
ADMIN
340B ID
CH091230
Grant Number
H80CS00631
Additional Details
Current Program Status
Active
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
8/28/2003
Last Recertification Date
2/11/2025
Contacts
Authorizing Official
La Clinica de La Raza
Jane Garcia, CEO
(510) 535-4000
Primary Contact
La Clinica de La Raza
Dolly Davar, Pharmacy Director
(510) 535-3382
Addresses
Street Address
1450 FRUITVALE AVE,
3RD FLOOR
OAKLAND, CA 94601
Billing Address
LA CLINICA DE LA RAZA
P.O. BOX 22210
OAKLAND, CA 94623
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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6/8/10 ADDED BILL TO; ADD RX ADDRESS
06/08/2010
April 2025
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