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CHC12872-14 WELLSPACE HEALTH (Terminated)
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Main Details
Name
WELLSPACE HEALTH
Subdivision Name
WellSpace Health - South Area Pediatric (#16)
Type
HRSA-Funded Health Center
Site ID
BPS-H80-017979
340B ID
CHC12872-14
Grant Number
H80CS12872
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2016
Participating Start Date
10/1/2016
Participating Approval Date
7/21/2016
Last Recertification Date
2/20/2017
Termination Date
Termination Reason
4/1/2018
Failure to recertify
Contacts
Authorizing Official
Kathy Walker, CFO
(916) 313-8455
Primary Contact
Kathy Walker, CFO
(916) 313-8455
Addresses
Street Address
3811 Florin Rd, Ste 16 Sacramento, CA 95823-5408
Sacramento, CA 95823-5408
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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