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CH10079AD La Clinica Del Valle Family Health Care Center, Inc. (Terminated)
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Main Details
Name
La Clinica Del Valle Family Health Care Center, Inc.
Subdivision Name
La Clinica Acute Care Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-031822
340B ID
CH10079AD
Grant Number
H80CS00759
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/15/2021
Last Recertification Date
1/30/2024
Termination Date
Termination Reason
1/1/2025
Other
Contacts
Authorizing Official
La Clinica del Valle
Traci Fossen, Chief Quality Officer
(541) 512-3912
Primary Contact
La Clinica del Valle
Sochil Castillo, Compliance Coordinator
(541) 512-3127
Addresses
Street Address
616 Market St
Medford, OR 97504-6126
Billing Address
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
931 Chevy Way
Medford, OR 97504
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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May 2025
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