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CH09538F Marin Community Clinic (Terminated)
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Main Details
Name
Marin Community Clinic
Subdivision Name
Marin Community Clinic - 4th Street Dental Suite C
Type
HRSA-Funded Health Center
Site ID
BPS-H80-024858
340B ID
CH09538F
Grant Number
H80CS00343
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/16/2020
Last Recertification Date
2/3/2021
Termination Date
Termination Reason
1/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Marin Community Clinics
Mitesh Popat, CEO
(415) 755-2581
Primary Contact
Marin Community Clinic
Isabela Mihai, Compliance Officer
(415) 755-2509
Addresses
Street Address
411 4th St Ste C
San Rafael, CA 94901-5716
Billing Address
Marin Community Clinic
9 Commercial Blvd, Ste 100
Novato, CA 94949
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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