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CHC26613-00 ANTELOPE VALLEY COMMUNITY CLINIC (Terminated)
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Main Details
Name
ANTELOPE VALLEY COMMUNITY CLINIC
Subdivision Name
Antelope Valley Community Clinic - Health and Wellness Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-013341
340B ID
CHC26613-00
Grant Number
H80CS26613
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2014
Participating Start Date
4/1/2014
Participating Approval Date
1/13/2014
Last Recertification Date
2/1/2019
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Antelope Valley Community Clinic
James A. Cook, CEO
(661) 942-2391
Primary Contact
Antelope Valley Community Clinic
Sheila Dizon, Special Projects / Data Support
(661) 942-2391
Addresses
Street Address
45104 10th St W
Lancaster, CA 93534-2310
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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