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CH09788M Petaluma Health Center, Inc. (Active)
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Main Details
Name
Petaluma Health Center, Inc.
Subdivision Name
Petaluma Health Center, Inc. Mobile Unit
Type
HRSA-Funded Health Center
Site ID
BPS-H80-033675
340B ID
CH09788M
Grant Number
H80CS00587
Additional Details
Current Program Status
Active
Registration Date
7/15/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/19/2022
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Petaluma Health Center
Molly Jouaneh, Chief Financial Officer
(707) 559-7500
Primary Contact
Petaluma Health Center
Pedro Toledo, Chief Executive Officer
(707) 326-7551
Addresses
Street Address
5900 State Farm Dr
Rohnert Park, CA 94928-2149
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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