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CH09901AP BORREGO COMMUNITY HEALTH FOUNDATION (Terminated)
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Main Details
Name
BORREGO COMMUNITY HEALTH FOUNDATION
Subdivision Name
MARTHAS VILLAGE CLINIC
Type
HRSA-Funded Health Center
Site ID
BPS-H80-029987
340B ID
CH09901AP
Grant Number
H80CS00287
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/21/2020
Last Recertification Date
2/14/2023
Termination Date
Termination Reason
4/1/2024
Failure to recertify
Contacts
Authorizing Official
BORREGO COMMUNITY HEALTH FOUNDATION
Rose MacIsaac, CEO
(760) 767-6684
Primary Contact
Borrego Community Health Foundation - Borrego Springs, CA
Guanzhong Yao Lo, Pharmacist
(760) 507-3300
Addresses
Street Address
83791 Date Ave
Indio, CA 92201-4737
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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