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CH06033F EL CENTRO FAMILY HEALTH (Terminated)
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Main Details
Name
EL CENTRO FAMILY HEALTH
Subdivision Name
HIGHLANDS UNIV STUDENT CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-006497
340B ID
CH06033F
Grant Number
H80CS00605
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2002
Participating Start Date
4/1/2002
Participating Approval Date
7/14/2011
Last Recertification Date
2/22/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
El Centro Family Health
Darren Deyapp, CEO
(505) 753-7218
Primary Contact
El Centro Family Health
Christine Vigil, Director of Pharmacy Services
(505) 753-7395
Addresses
Street Address
901 Baca Street
LAS VEGAS, NM 87701
Billing Address
EL CENTRO FAMILY HEALTH
PO BOX 158
ESPANOLA, NM 87532
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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3/23/07 - UPDATED ENTITY NAME (WAS HEALTH CENTERS OF NORTHERN NM) 7/14/11 - CHANGED PHYSICAL ADDRESS FROM MORA & BACA 9TH STREET.
07/14/2011
3/23/07 - UPDATED ENTITY NAME (WAS HEALTH CENTERS OF NORTHERN NM) 7/14/11 - CHANGED PHYSICAL ADDRESS FROM MORA & BACA 9TH STREET.
07/14/2011
June 2025
June 2025
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