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CH09108AW CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC. (ToBeTerminated)
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Main Details
Name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Subdivision Name
San Ysidro Health Corporate Office
Type
HRSA-Funded Health Center
Site ID
BPS-H80-027073
340B ID
CH09108AW
Grant Number
H80CS10748
Additional Details
Current Program Status
ToBeTerminated
Registration Date
1/14/2021
Participating Start Date
4/1/2021
Participating Approval Date
1/21/2021
Last Recertification Date
2/25/2025
Termination Date
Termination Reason
7/1/2025
Never implemented the 340B Program
Contacts
Authorizing Official
Centro de Salud de la Comunidad de San Ysidro, Inc.
Brian Wallace, VP of Finance & CFO
(619) 662-4100
Primary Contact
Centro de Salud de la Comunidad de San Ysidro Inc.
Douglas Israel, Director of Contracts
(619) 662-4165
Addresses
Street Address
1601 Precision Park Ln
San Diego, CA 92173-1345
Billing Address
San Ysidro Health San Ysidro Health Center
4004 Beyer Blvd
San Ysidro, CA 92173
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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