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FQHCLA311 Greater Fresno Health Organization (Active)
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Main Details
Name
Greater Fresno Health Organization
Subdivision Name
Kings Winery Medical Clinic
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-009767
340B ID
FQHCLA311
Grant Number
LALCS00041
Additional Details
Current Program Status
Active
Registration Date
7/13/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/1/2018
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
GREATER FRESNO HEALTH ORGANIZATION
BLA MOUANOUTOUA, CEO
(559) 255-6476 Ext: 4290
Primary Contact
Greater Fresno Health Organization
Torey Lam, 340B Manager
(808) 499-5491
Addresses
Street Address
4929 E Cesar Chavez Blvd
Fresno, CA 93727-3812
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Participating from effective date (7/1/2013) until terminated effective date (4/1/2018), reinstatement date effective date (10/01/2018)
07/31/2018
April 2025
April 2025
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