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CH091140 SAN MATEO, COUNTY OF (Active)
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Main Details
Name
SAN MATEO, COUNTY OF
Subdivision Name
39th Outpatient Clinics
Type
HRSA-Funded Health Center
Site ID
BPS-H80-000595
340B ID
CH091140
Grant Number
H80CS00051
Additional Details
Current Program Status
Active
Registration Date
10/1/2001
Participating Start Date
10/1/2001
Participating Approval Date
11/17/2004
Last Recertification Date
3/5/2025
Contacts
Authorizing Official
San Mateo Medical Center
CHESTER J. KUNNAPPILLY, CEO
(650) 573-2305
Primary Contact
San Mateo Medical Center
Victor Armendariz, Director of Pharmacy
(650) 573-2366
Addresses
Street Address
222 W 39th Ave
San Mateo, CA 94403-4364
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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3/30/12-Changed authorizing official (was SANG-ICK CHANG, M.D.); 11/09/04 - ADMIN CORRECTION - COMBINES OLD RECORDS CH094100 AND HO091140J
03/30/2012
11/09/04 - ADMIN CORRECTION - COMBINES OLD RECORDS CH094100 AND HO091140J
12/11/2008
May 2025
May 2025
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