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CH10079AB La Clinica Del Valle Family Health Care Center, Inc. (Active)
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Main Details
Name
La Clinica Del Valle Family Health Care Center, Inc.
Subdivision Name
La Clinica School-Based Health Center at Talent Elementary School
Type
HRSA-Funded Health Center
Site ID
BPS-H80-032024
340B ID
CH10079AB
Grant Number
H80CS00759
Additional Details
Current Program Status
Active
Registration Date
4/12/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/15/2021
Last Recertification Date
2/12/2025
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
307 Wagner Creek Street RM 8 & 9
Talent, OR 97540-0000
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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