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CH09108BE CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC. (Active)
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Main Details
Name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Subdivision Name
San Ysidro Health San Diego PACE Vista
Type
HRSA-Funded Health Center
Site ID
BPS-H80-034336
340B ID
CH09108BE
Grant Number
H80CS10748
Additional Details
Current Program Status
Active
Registration Date
4/15/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/18/2022
Last Recertification Date
3/5/2025
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
1840 West Dr
Vista, CA 92083-6115
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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