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FQHCLA321B Southern California Medical Center (Terminated)
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Main Details
Name
Southern California Medical Center
Subdivision Name
Southern California Medical Center, Inc.
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-014717
340B ID
FQHCLA321B
Grant Number
LALCS00144
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/30/2015
Last Recertification Date
2/11/2019
Termination Date
Termination Reason
7/1/2019
Other
Contacts
Authorizing Official
Southern California Medical Center
Abbas Hosseini, System Manager
(818) 421-1035
Primary Contact
Southern California Medical Center
Abbas Hosseini, Data Analyst
(818) 650-6700 Ext: 226
Addresses
Street Address
14550 HAYNES ST
VAN NUYS, CA 91411-1613
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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