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FQHCLA382 LAGUNA BEACH COMMUNITY CLINIC INC (Active)
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Main Details
Name
LAGUNA BEACH COMMUNITY CLINIC INC
Subdivision Name
Laguna Beach Community Clinic
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-027016
340B ID
FQHCLA382
Grant Number
LALCS32582
Additional Details
Current Program Status
Active
Registration Date
1/14/2019
Participating Start Date
4/1/2019
Participating Approval Date
3/8/2019
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Laguna Beach Community Clinic
Jorge Rubal, C.E.O. / C.M.O.
(949) 494-0761 Ext: 132
Primary Contact
Laguna Beach Community Clinic
Patrick Wood, CFO
(949) 494-0761 Ext: 123
Addresses
Street Address
362 Third Street
Laguna Beach, CA 92651
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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