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CH10079V La Clinica Del Valle Family Health Care Center Inc (Terminated)
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Main Details
Name
La Clinica Del Valle Family Health Care Center Inc
Subdivision Name
La Clinica School-Based Health Center at Kids Unlimited
Type
HRSA-Funded Health Center
Site ID
BPS-H80-024876
340B ID
CH10079V
Grant Number
H80CS00759
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/14/2019
Last Recertification Date
2/15/2022
Termination Date
Termination Reason
10/1/2022
Site closure
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
821 N Riverside Ave
Medford, OR 97501-4610
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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