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CH09108BB 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 Alpine Pediatric Medical Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-032326
340B ID
CH09108BB
Grant Number
H80CS10748
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/18/2021
Last Recertification Date
2/1/2022
Termination Date
Termination Reason
1/1/2023
Site closure
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
2733 Alpine Blvd Ste 200
Alpine, CA 91901-2253
Billing Address
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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