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CH09072S NORTH COUNTY HEALTH PROJECT INCORPORATED (Terminated)
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Main Details
Name
NORTH COUNTY HEALTH PROJECT INCORPORATED
Subdivision Name
Mark Ventocilla OD Inc. an Affiliate of NCHS
Type
HRSA-Funded Health Center
Site ID
BPS-H80-015383
340B ID
CH09072S
Grant Number
H80CS00228
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/10/2016
Last Recertification Date
2/17/2017
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
NCHS
Patrick Tellez, CMO
(760) 736-8689
Primary Contact
NCHS
Kory Hernandez, Director of Operations
(760) 736-1722
Addresses
Street Address
613 East Grand Ave.
Escondido, CA 92025-2550
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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