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FQHCLA328G SAN JOAQUIN, COUNTY OF (Terminated)
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Main Details
Name
SAN JOAQUIN, COUNTY OF
Subdivision Name
Manteca Clinic
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-020767
340B ID
FQHCLA328G
Grant Number
LALCS00158
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/14/2017
Last Recertification Date
1/28/2020
Termination Date
Termination Reason
4/1/2021
Site closure
Contacts
Authorizing Official
San Joaquin County Clinics
Farhan Fadoo, Chief Executive Officer
(209) 953-3700
Primary Contact
San Joaquin County Clinics
Betty Jo Riendel, Clinic Nursing Manager
(209) 468-6177
Addresses
Street Address
283 Spreckels Avenue
Manteca, CA 95336-6005
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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