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CHC28366-01 HARBOR COMMUNITY CLINIC (Terminated)
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Main Details
Name
HARBOR COMMUNITY CLINIC
Subdivision Name
Beacon Street Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-015128
340B ID
CHC28366-01
Grant Number
H80CS28366
Additional Details
Current Program Status
Terminated
Registration Date
10/8/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/16/2015
Last Recertification Date
2/7/2023
Termination Date
Termination Reason
4/1/2024
Site closure
Contacts
Authorizing Official
Harbor Community Clinic
Nathalia Jimenez, COO
(310) 547-0202 Ext: 134
Primary Contact
Harbor Community Clinic
Dahina Hernandez, Director of Operations
(310) 547-0202
Addresses
Street Address
731 S. Beacon Street
San Pedro, CA 90731
Billing Address
Harbor Community Clinic
593 West 6th Street
San Pedro, CA 90731
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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