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CH06658D Centro San Vicente's Wellness Center at Emergence Healthcare Network (Terminated)
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Main Details
Name
Centro San Vicente's Wellness Center at Emergence Healthcare Network
Subdivision Name
Type
HRSA-Funded Health Center
Site ID
BPS-H80-016987
340B ID
CH06658D
Grant Number
H80CS00637
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2016
Participating Start Date
4/1/2016
Participating Approval Date
1/11/2016
Last Recertification Date
2/16/2021
Termination Date
Termination Reason
10/1/2021
Site closure
Contacts
Authorizing Official
Centro San Vicente
Christina Ilene Paz, CEO
(915) 859-7545 Ext: 1232
Primary Contact
Centro San Vicente
Ana Nicoletto, Director of Pharmacy
(915) 859-7545 Ext: 1241
Addresses
Street Address
1600 MONTANA AVE
EL PASO, TX 79902-5622
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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