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CH09489G Venice Family Clinic (Active)
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Main Details
Name
Venice Family Clinic
Subdivision Name
Venice Family Clinic - South Bay Family Health Care - Gardena
Type
HRSA-Funded Health Center
Site ID
BPS-H80-033913
340B ID
CH09489G
Grant Number
H80CS04217
Additional Details
Current Program Status
Active
Registration Date
11/29/2021
Participating Start Date
12/3/2021
Participating Approval Date
11/30/2021
Last Recertification Date
2/14/2025
Contacts
Authorizing Official
Venice Family Clinic
Mitesh G Popat, CEO
(310) 664-7901
Primary Contact
Venice Family Clinic
Isabela Mihai, Chief Compliance Officer
(415) 870-5955
Addresses
Street Address
742 W Gardena Blvd
Gardena, CA 90247-5024
Billing Address
Venice Family Clinic
604 Rose Avenue
Venice, CA 90291
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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