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FQHCLA425 SUNRISE CLINICS (Active)
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Main Details
Name
SUNRISE CLINICS
Subdivision Name
Sunrise Clinics - Santa Rosa
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-032095
340B ID
FQHCLA425
Grant Number
LALCS40211
Additional Details
Current Program Status
Active
Registration Date
4/8/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/15/2021
Last Recertification Date
2/11/2025
Contacts
Authorizing Official
Sunrise Clinics
Randal Brown, CEO
(575) 472-4311
Primary Contact
Sunrise Clinics
Greg Stuart, Pharmacy Administrator
(805) 630-6350
Addresses
Street Address
117 Camino De Vida Ste 300
Santa Rosa, NM 88435-2267
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
June 2025
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