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CHC11402-11 NORTHEAST COMMUNITY CLINIC, INC (Terminated)
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Main Details
Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic - Highland Park
Type
HRSA-Funded Health Center
Site ID
BPS-H80-011366
340B ID
CHC11402-11
Grant Number
H80CS12869
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2014
Participating Start Date
10/1/2014
Participating Approval Date
7/23/2014
Last Recertification Date
2/21/2019
Termination Date
Termination Reason
10/1/2019
Other
Contacts
Authorizing Official
Northeast Community Clinic
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Primary Contact
Northeast Community Clinic
Estefania Pulido Verduzco, Executive Assistant
(626) 457-6900
Addresses
Street Address
5420 N Figueroa St
Los Angeles, CA 90042-4118
Billing Address
NORTHEAST COMMUNITY CLINIC
2550 W. MAIN ST. SUITE 301
ALHAMBRA, CA 91801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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