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FP902914 VENICE FAMILY CLINIC (Terminated)
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Main Details
Name
VENICE FAMILY CLINIC
Subdivision Name
VENICE FAMILY CLINIC
Type
Family Planning (Title X only)
340B ID
FP902914
Grant Number
FPHPA006470-01-00
Additional Details
Current Program Status
Terminated
Registration Date
1/1/1998
Participating Start Date
1/1/1998
Participating Approval Date
1/1/1998
Last Recertification Date
5/4/2020
Termination Date
Termination Reason
7/1/2020
Other
Contacts
Authorizing Official
Venice Family Clinic
ELIZABETH BENSON FORER, EXECUTIVE DIRECTOR
(310) 664-7901
Primary Contact
Venice Family Clinic
Sharon Ng, Director of Pharmacy
(310) 664-7735
Addresses
Street Address
604 ROSE AVE
VENICE, CA 90291
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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2/29/12 added sub-div name; 2/17/10 ADDED MEDICAID #;
02/29/2012
2/17/10 ADDED MEDICAID #;
02/17/2010
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