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FQHC638549 mathiesen memorial Health Clinic (Active)
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Main Details
Name
mathiesen memorial Health Clinic
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638549
Additional Details
Current Program Status
Active
Registration Date
1/9/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/25/2018
Last Recertification Date
2/28/2025
Contacts
Authorizing Official
Mathiesen Memorial Health Clinic
John Richard Vass, CEO
(209) 984-4827 Ext: 2099844827
Primary Contact
Mathiesen Memorial Health Clinc
Kristofer Moore, 340B Manager
(209) 984-4827 Ext: 2099844827
Addresses
Street Address
18144 Seco Street
Jamestown, CA 95327
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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April 2025
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