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CH091080 SAN YSIDRO HEALTH CENTER (Active)
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Main Details
Name
SAN YSIDRO HEALTH CENTER
Subdivision Name
San Ysidro Health San Ysidro Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-005050
340B ID
CH091080
Grant Number
H80CS10748
Additional Details
Current Program Status
Active
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
2/9/2009
Last Recertification Date
3/4/2025
Contacts
Authorizing Official
Centro de Salud de la Comunidad de San Ysidro, Inc.
Brian Wallace, VP of Finance & CFO
(619) 662-4100
Primary Contact
Centro de Salud de la Comunidad de San Ysidro Inc.
Douglas Israel, Director of Contracts
(619) 662-4165
Addresses
Street Address
4004 BEYER BLVD
San Ysidro, CA 92173
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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KB - 2/9/09 - GRANT NUMBER CHANGED (FORMER #H80CS00227)
02/09/2009
May 2025
May 2025
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