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CHC24113-11 ELICA HEALTH CENTERS (Terminated)
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Main Details
Name
ELICA HEALTH CENTERS
Subdivision Name
Harbor Medical Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-019604
340B ID
CHC24113-11
Grant Number
H80CS24113
Additional Details
Current Program Status
Terminated
Registration Date
10/2/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/3/2017
Last Recertification Date
3/5/2018
Termination Date
Termination Reason
4/1/2019
Site closure
Contacts
Authorizing Official
Elica Health Centers
Tatyana Bak, CEO
(916) 569-8484 Ext: 309
Primary Contact
Elica Health Centers
Laton Fuller, Chief Compliance Officer
(916) 569-8484 Ext: 383
Addresses
Street Address
804 Harbor Blvd.
West Sacramento, CA 95691
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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