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FQHCLA81U NORTHEAST COMMUNITY CLINIC, INC (Active)
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Main Details
Name
NORTHEAST COMMUNITY CLINIC, INC
Subdivision Name
Northeast Community Clinic Mobile Medical Van
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-009876
340B ID
FQHCLA81U
Grant Number
LALCS00033
Additional Details
Current Program Status
Active
Registration Date
7/15/2019
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
5820 N Figueroa St
Los Angeles, CA 90042-4228
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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