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CH09123E LA CLINICA DE LA RAZA, INC. (Active)
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Main Details
Name
LA CLINICA DE LA RAZA, INC.
Subdivision Name
LA CLINICA DE LA RAZA
Type
HRSA-Funded Health Center
Site ID
BPS-H80-002390
340B ID
CH09123E
Grant Number
H80CS00631
Additional Details
Current Program Status
Active
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
6/8/2010
Last Recertification Date
2/11/2025
Contacts
Authorizing Official
La Clinica de La Raza
Jane Garcia, CEO
(510) 535-4000
Primary Contact
La Clinica de La Raza
Dolly Davar, Pharmacy Director
(510) 535-3382
Addresses
Street Address
3451 E 12th St
Oakland, CA 94601-3425
Billing Address
LA CLINICA DE LA RAZA
P.O. BOX 22210
OAKLAND, CA 94623
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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6/8/10 UPDATED BILL TO (WAS 1515 FRUITVALE AVE, 94601); 6/12/06 - ADDRESS CHANGE (WAS AT 2647 INTERNATIONAL BLVD), 8/29/06 - ADDED SHIPPING ADDRESS
06/08/2010
April 2025
April 2025
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