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CH092176M WESTERN SIERRA MEDICAL CLINIC, INC. (Terminated)
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Main Details
Name
WESTERN SIERRA MEDICAL CLINIC, INC.
Subdivision Name
Temporary Site - Hospitality House
Type
HRSA-Funded Health Center
Site ID
BPS-H80-032041
340B ID
CH092176M
Grant Number
H80CS08234
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/16/2024
Last Recertification Date
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Western Sierra Medical Clinic
Jennifer Malone, CEO
(530) 273-3819
Primary Contact
Western Sierra Medical Clinic
Francine Novak, Chief Planning and Development Officer
(530) 273-4984 Ext: 102
Addresses
Street Address
1262 Sutton Way
Grass Valley, CA 95945-5175
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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May 2025
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