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CH09489C VENICE FAMILY CLINIC (Active)
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Main Details
Name
VENICE FAMILY CLINIC
Subdivision Name
Robert Levine Family Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-011833
340B ID
CH09489C
Grant Number
H80CS04217
Additional Details
Current Program Status
Active
Registration Date
10/14/2014
Participating Start Date
1/1/2015
Participating Approval Date
10/23/2014
Last Recertification Date
2/14/2025
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
905 Venice Blvd
Venice, CA 90291-4904
Billing Address
Venice Family Clinic
604 Rose Avenue
Venice, CA 90291
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
June 2025
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