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FQHCLA321A Southern California Medical Center (Terminated)
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Main Details
Name
Southern California Medical Center
Subdivision Name
Southern California Medical Center
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-012827
340B ID
FQHCLA321A
Grant Number
LALCS00144
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/14/2013
Last Recertification Date
1/28/2015
Termination Date
Termination Reason
1/1/2016
Loss of qualifying grant/support
Contacts
Authorizing Official
Southern California Medical Center
Sheila Busheri, CEO
(818) 324-3780
Primary Contact
Rebecca Casarotti, COO
(562) 699-4477
Addresses
Street Address
12100 Valley Blvd.
El Monte, CA 91732-3100
Billing Address
Southern California Medical Center, Inc.
12100 Valley Blvd Ste 109A
El Monte, CA 91732-3100
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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