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CHC28979-00 DAVIS STREET COMMUNITY CENTER INC (Active)
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Main Details
Name
DAVIS STREET COMMUNITY CENTER INC
Subdivision Name
Davis Street Primary Care Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-015601
340B ID
CHC28979-00
Grant Number
H80CS28979
Additional Details
Current Program Status
Active
Registration Date
4/20/2021
Participating Start Date
4/28/2021
Participating Approval Date
4/28/2021
Last Recertification Date
3/5/2025
Contacts
Authorizing Official
Davis Street Primary Care Clinic
Daniel Kenneth Johnson, CEO
(510) 347-4620 Ext: 104
Primary Contact
Davis Street Community Center Inc
Carole McKindley-Alvarez, Clinic Operations Director
(510) 347-4620 Ext: 143
Addresses
Street Address
3081 TEAGARDEN ST
SAN LEANDRO, CA 94577-5720
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Participated 1/1/16 until terminated 4/1/21, reinstated effective 4/28/21.
04/28/2021
April 2025
April 2025
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