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FQHCLA321 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-012828
340B ID
FQHCLA321
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
2/11/2019
Termination Date
Termination Reason
7/1/2019
Other
Contacts
Authorizing Official
Southern California Medical Center
Abbas Hosseini, System Manager
(818) 421-1035
Primary Contact
Southern California Medical Center
Abbas Hosseini, Data Analyst
(818) 650-6700 Ext: 226
Addresses
Street Address
8825 Whittier Blvd.
Pico Rivera, CA 90660-2600
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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9/29/15 terminated in error, FQHCLA321A should have been terminated, error was caught immediately and termination was reversed
09/29/2015
May 2025
May 2025
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