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CH06301Y CLINICA DE FAMILIA INC, LA (Terminated)
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Main Details
Name
CLINICA DE FAMILIA INC, LA
Subdivision Name
Griggs Assertive Community Treatment
Type
HRSA-Funded Health Center
Site ID
BPS-H80-016955
340B ID
CH06301Y
Grant Number
H80CS00316
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/19/2016
Last Recertification Date
2/26/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
La Clinica de Familia, Inc.
Virgil Medina, CEO
(575) 526-1105
Primary Contact
La Clinica de Familia, Inc.
Olivia Martinez, Accounting Manager
(575) 526-1105
Addresses
Street Address
105 W Griggs Ave.
Las Cruces, NM 88001-1235
Billing Address
La Clinica de Familia, Inc.
385 Calle de Alegra, Bldg A
Las Cruces, NM 88005
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
June 2025
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