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CH09108BD 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 Physicians Health Institute for Women
Type
HRSA-Funded Health Center
Site ID
BPS-H80-032453
340B ID
CH09108BD
Grant Number
H80CS10748
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/27/2022
Last Recertification Date
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
550 Washington St Ste 331
San Diego, CA 92103-2227
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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