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FQHCLA81T NORTHEAST COMMUNITY CLINIC, INC (Active)
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Main Details
Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-024835
340B ID
FQHCLA81T
Grant Number
LALCS00033
Additional Details
Current Program Status
Active
Registration Date
7/2/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/5/2019
Last Recertification Date
3/4/2025
Contacts
Authorizing Official
Northeast Community Clinic
CHRISTOPHER LAU, EXECUTIVE DIRECTOR
(626) 457-6900
Primary Contact
Northeast Community Clinic
Emely Orozco, Pharmacy Program Administrator
(626) 457-5209
Addresses
Street Address
4455 W 117th St Ste 502
Hawthorne, CA 90250-2261
Billing Address
Northeast Community Clinic
2550 West Main Street
301
Alhambra, CA 91801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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May 2025
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