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CH100790 LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC (Active)
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Main Details
Name
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
Subdivision Name
PHOENIX HEALTH CENTER--LA CLINICA
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001238
340B ID
CH100790
Grant Number
H80CS00759
Additional Details
Current Program Status
Active
Registration Date
1/1/1999
Participating Start Date
1/1/1999
Participating Approval Date
3/11/2004
Last Recertification Date
2/12/2025
Contacts
Authorizing Official
La Clinica del Valle
Traci Fossen, Chief Quality Officer
(541) 512-3912
Primary Contact
La Clinica del Valle
Sochil Castillo, Compliance Coordinator
(541) 512-3127
Addresses
Street Address
3617 S Pacific Hwy
Medford, OR 97501-8957
Billing Address
La Clinica Del Valle Family Health Care Center Inc
931 Chevy Way
Medford, OR 97504
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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ENT NAME CORRECTION, NEW CONTACT
03/11/2004
April 2025
April 2025
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