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FQHCLA311A Greater Fresno Health Organization (Active)
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Main Details
Name
Greater Fresno Health Organization
Subdivision Name
North Marks Medical Clinic
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-013858
340B ID
FQHCLA311A
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
4011 N Marks Ave
Fresno, CA 93722-4555
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 (10/1/2014) 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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