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CH09123AF LA CLINICA DE LA RAZA, INC. (Terminated)
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Main Details
Name
LA CLINICA DE LA RAZA, INC.
Subdivision Name
La Clinica Dental at Elsa Widenmann Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-017192
340B ID
CH09123AF
Grant Number
H80CS00631
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/16/2016
Last Recertification Date
2/1/2022
Termination Date
Termination Reason
4/1/2023
Site closure
Contacts
Authorizing Official
La Clinica de La Raza
Jane Garcia, CEO
(510) 535-4000
Primary Contact
La Clinica de La Raza
Dolly Davar, Pharmacy Director
(510) 535-3382
Addresses
Street Address
100 Whitney Ave
Vallejo, CA 94589-2194
Billing Address
La Clinica de La Raza, Inc.
PO Box 22210
Oakland, CA 94623
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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