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CHC26619-00 KEDREN COMMUNITY HEALTH CENTER, INC. (Active)
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Main Details
Name
KEDREN COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Kedren Community Care Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-013327
340B ID
CHC26619-00
Grant Number
H80CS26619
Additional Details
Current Program Status
Active
Registration Date
5/21/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/23/2018
Last Recertification Date
2/11/2025
Contacts
Authorizing Official
KEDREN COMMUNITY HEALTH CENTER, INC.
MARIA FE V MARFORI, CFO
(323) 802-0308
Primary Contact
Kedren
Kelly Jones, Chief Medical Officer
(323) 234-0616
Addresses
Street Address
4211 Avalon Blvd. Suite A
Los Angeles, CA 90011-5622
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Participating 7/1/2015 until terminated effective 4/1/2018, reinstated effective 7/1/2018.
05/23/2018
5/11/15 participating 1/1/15 thru 3/31/15, not participating 4/1/15 thru 6/30/15 due to failure to recertify, reinstated based on on-line registration submitted in April 2015
05/11/2015
April 2025
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