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CHC24115-02 SABAN FREE CLINIC, THE (Active)
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Main Details
Name
SABAN FREE CLINIC, THE
Subdivision Name
Hollywood Wilshire Health Center and Wallis Annenberg Children & Family Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-011778
340B ID
CHC24115-02
Grant Number
H80CS24115
Additional Details
Current Program Status
Active
Registration Date
8/17/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/11/2012
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Saban Community Clinic
Muriel Nouwezem, CEO
(323) 337-1707
Primary Contact
Saban Free CLinic
Raed Ahmed, Pharmacy Services Manager
(323) 337-1812
Addresses
Street Address
5205 Melrose Ave.
Los Angeles, CA 90038-3144
Billing Address
Saban Community Clinic
8405 Beverly Blvd.
Los Angeles, CA 90048
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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