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CH09100AG NORTHEAST VALLEY HEALTH CORPORATION (Terminated)
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Main Details
Name
NORTHEAST VALLEY HEALTH CORPORATION
Subdivision Name
NEVHC Rainbow Dental Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-012149
340B ID
CH09100AG
Grant Number
H80CS00139
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2013
Participating Start Date
4/1/2013
Participating Approval Date
1/24/2013
Last Recertification Date
2/1/2022
Termination Date
Termination Reason
4/1/2023
Other
Contacts
Authorizing Official
Northeast Valley Health Corporation
Kimberly Wyard, Chief Executive Officer
(818) 898-1388 Ext: 41620
Primary Contact
Northeast Valley Health Corporation
Artashes R Khachatryan, Pharmacy Director/Primary Contact
(818) 365-8086 Ext: 50205
Addresses
Street Address
26974 Rainbow Glen Dr
Canyon Country, CA 91351-4875
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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