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CH09108AB CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC. (Active)
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Main Details
Name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Subdivision Name
San Ysidro Health Wellness Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-021026
340B ID
CH09108AB
Grant Number
H80CS10748
Additional Details
Current Program Status
Active
Registration Date
3/7/2018
Participating Start Date
4/1/2018
Participating Approval Date
3/7/2018
Last Recertification Date
2/25/2025
Contacts
Authorizing Official
Centro de Salud de la Comunidad de San Ysidro, Inc.
Brian Wallace, VP of Finance & CFO
(619) 662-4100
Primary Contact
Centro de Salud de la Comunidad de San Ysidro Inc.
Douglas Israel, Director of Contracts
(619) 662-4165
Addresses
Street Address
855 Third Avenue Suite 2200
Chula Vista, CA 91911
Billing Address
San Ysidro Health Center
4004 Beyer Boulevard
San Ysidro, CA 92173
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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