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RWI921010 Christie's Place, Inc. (Terminated)
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Main Details
Name
Christie's Place, Inc.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI921010
Grant Number
H89HA00001
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/6/2020
Last Recertification Date
Time Period the Assistance was Received
Termination Date
Termination Reason
4/1/2021
Failure to recertify
Contacts
Authorizing Official
Christie's Place
Rhea Van Brocklin, Executive Director
(619) 702-4186 Ext: 6197024186
Primary Contact
Christie's Place
Holly F Carbone, Clinical Director
(619) 702-4186 Ext: 307
Addresses
Street Address
2440 Third Avenue
San Diego, CA 92101
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date: (1/1/2017), until terminated effective date: (4/1/2019), reinstatement effective date: (04/012020).
02/20/2020
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