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FQHCLA308A Universal Community Health Center (Terminated)
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Main Details
Name
Universal Community Health Center
Subdivision Name
Universal Community Health Center - San Pedro St.
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-017783
340B ID
FQHCLA308A
Grant Number
H80CS30722
Additional Details
Current Program Status
Terminated
Registration Date
7/5/2016
Participating Start Date
10/1/2016
Participating Approval Date
7/6/2016
Last Recertification Date
1/30/2019
Termination Date
Termination Reason
7/1/2019
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Universal Community Health Center
Edgar Alexander Chavez, CEO
(323) 485-0467
Primary Contact
Universal Community Health Center
Alfredo 3233135588 Reynoso, Chief Operations Officer
(323) 233-3100 Ext: 144
Addresses
Street Address
2801 S. San Pedro St.
Los Angeles, CA 90011
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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