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CH092535J SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC (Terminated)
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Main Details
Name
SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC
Subdivision Name
Monterey Plaza Health Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-014386
340B ID
CH092535J
Grant Number
H80CS06646
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/17/2016
Last Recertification Date
1/27/2020
Termination Date
Termination Reason
1/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Foothill Community Health Center
Salvador Chavarin, Chief Executive Officer
(408) 729-4290
Primary Contact
Bay Area Community Health
NEIL KOZUMA, Development Director
(408) 729-4290 Ext: 4087294290
Addresses
Street Address
5504 MONTEREY HWY
SAN JOSE, CA 95138-1529
Billing Address
San Jose Foothill Family Community Clinic
2670 S. White Road, Suite 200
San Jose, CA 95148
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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