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CH09489B VENICE FAMILY CLINIC (Active)
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Main Details
Name
VENICE FAMILY CLINIC
Subdivision Name
OPCC Access Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-011791
340B ID
CH09489B
Grant Number
H80CS04217
Additional Details
Current Program Status
Active
Registration Date
4/8/2014
Participating Start Date
7/1/2014
Participating Approval Date
4/29/2014
Last Recertification Date
2/23/2025
Contacts
Authorizing Official
Venice Family Clinic
Mitesh G Popat, CEO
(310) 664-7901
Primary Contact
Venice Family Clinic
Isabela Mihai, Chief Compliance Officer
(310) 593-9594
Addresses
Street Address
503 Olympic Blvd
Santa Monica, CA 90401-3311
Billing Address
Venice Family Clinic
604 Rose Ave
Venice, CA 90291
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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