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CH10079G LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC (Terminated)
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Main Details
Name
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
Subdivision Name
Mobile Health Center--La Clinica
Type
HRSA-Funded Health Center
Site ID
BPS-H80-011259
340B ID
CH10079G
Grant Number
H80CS00759
Additional Details
Current Program Status
Terminated
Registration Date
8/13/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/11/2012
Last Recertification Date
2/12/2025
Termination Date
Termination Reason
4/1/2025
Other
Contacts
Authorizing Official
La Clinica del Valle
Traci Fossen, Chief Quality Officer
(541) 512-3912
Primary Contact
La Clinica del Valle
Sochil Castillo, Compliance Coordinator
(541) 512-3127
Addresses
Street Address
3617 S Pacific Hwy
Medford, OR 97501-8957
Billing Address
La Clinica Del Valle Family Health Care Center Inc.
931 Chevy Way
Medford, OR 97504
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
June 2025
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