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CH09108AY CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC. (Terminated)
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Main Details
Name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Subdivision Name
San Ysidro Health Tierra Del Rey
Type
HRSA-Funded Health Center
Site ID
BPS-H80-031999
340B ID
CH09108AY
Grant Number
H80CS10748
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/14/2021
Last Recertification Date
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Centro de Salud de la Comunidad de San Ysidro, Inc.
Kevin Mattson, President & CEO
(619) 662-6322
Primary Contact
Centro de Salud de la Comunidad de San Ysidro, Inc.
Brian Wallace, VP of Finance & CFO
(619) 662-4100
Addresses
Street Address
1061 Tierra Del Rey Ste 303-305
Chula Vista, CA 91910-7880
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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