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CHC26613-06 ANTELOPE VALLEY COMMUNITY CLINIC (Terminated)
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Main Details
Name
ANTELOPE VALLEY COMMUNITY CLINIC
Subdivision Name
Antelope Valley Community Clinic - Palmdale East
Type
HRSA-Funded Health Center
Site ID
BPS-H80-018777
340B ID
CHC26613-06
Grant Number
H80CS26613
Additional Details
Current Program Status
Terminated
Registration Date
5/22/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/24/2017
Last Recertification Date
2/1/2019
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Antelope Valley Community Clinic
James A. Cook, CEO
(661) 942-2391
Primary Contact
Antelope Valley Community Clinic
Sheila Dizon, Special Projects / Data Support
(661) 942-2391
Addresses
Street Address
37926 47th St. East
Palmdale, CA 93552
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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