Covered Entity Details

CH08165W CLINICA CAMPESINA/FAMILY HEALTH SERVICES (Active) - information as of 5/20/2025 12:45:51 AM

Main Details

Name

CLINICA CAMPESINA/FAMILY HEALTH SERVICES

Subdivision Name

Alicia Sanchez Elementary School

Type

HRSA-Funded Health Center

Site ID

BPS-H80-035018

340B ID

CH08165W

Grant Number

H80CS00690

Additional Details

Current Program Status

Active

Registration Date

4/10/2024

Participating Start Date

7/1/2024

Participating Approval Date

4/29/2024

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

Clinica Campesina Family Health Services
Simon Smith, CEO
(303) 665-3036 Ext: 1003

Primary Contact

Clinica Campesina Family Health Services
Melinda Gonzales, Pharmacy Director
(303) 665-3036 Ext: 2840

Addresses

Street Address

655 Sir Galahad Dr
Lafayette, CO 80026-1979

Billing Address

Clinica Campesina Family Health Services
1735 S Public Rd
Lafayette, CO 80026

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09598	1041 MAIN STREET	LONGMONT	CO	80501-4302	04/29/2024	07/01/2024			07/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH081650	Terminated	BPS-H80-002060	CLINICA CAMPESINA FAMILY HEALTH SERVICES	Clinica Family Health- Administration	1345 Plaza Ct N	Lafayette	CO
CH08165AA	Active	BPS-H80-035043	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	University Hill Elementary School	956 16th St	Boulder	CO
CH08165AB	Active	BPS-H80-034993	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Emerald Elementary School	275 Emerald St	Broomfield	CO
CH08165AC	Active	BPS-H80-039441	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Clinica Family Health & Wellness -- Norton Center for Behavioral Medicine	975 North St	Boulder	CO
CH08165AD	Active	BPS-H80-039438	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Clinica Family Health & Wellness -- Walk-In Crisis & Addiction Center	3180 Airport Rd	Boulder	CO
CH08165AE	Active	BPS-H80-039439	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Clinica Family Health & Wellness -- Wellness Education Center	834 S Sherman St	Longmont	CO
CH08165AF	Active	BPS-H80-039365	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Clinica Family Health & Wellness -- St. Vrain Community Hub	515 Coffman St	Longmont	CO
CH08165AG	Active	BPS-H80-039364	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Clinica Family Health & Wellness -- Dixon Clinic	1455 Dixon Ave	Lafayette	CO
CH08165AH	Active	BPS-H80-039440	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Clinica Family Health & Wellness -- Broomfield Clinic	897 Hwy 287 STE 200	Broomfield	CO
CH08165AJ	Active	BPS-H80-039437	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Clinica Family Health & Wellness -- Halcyon School	3100 Bucknell Ct	Boulder	CO
CH08165B	Active	BPS-H80-001251	Clinica Campesina Family Health Services	Clinica Family Health- Pecos	1701 W. 72ND AVE	DENVER	CO
CH08165C	Active	BPS-H80-003315	Clinica Campesina Family Health Services	Clinica Family Health - Thornton	8990 N. WASHINGTON ST	THORNTON	CO
CH08165E	Terminated	BPS-H80-000858	CLINICA CAMPESINA FAMILY HEALTH SERVICES	Clinica Family Health Services- Lafayette	2000 W SOUTH BOULDER	LAFAYETTE	CO
CH08165M	Active	BPS-H80-008441	Clinica Campesina Family Health Services	Clinica Family Health - People's	2525 13th St	Boulder	CO
CH08165N	Terminated	BPS-H80-011081	CLINICA CAMPESINA FAMILY HEALTH SERVICES	Clinica Family Health Services Federal Heights	8300 Alcott St STE 205	Westminster	CO
CH08165P	Active	BPS-H80-014347	Clinica Campesina Family Health Services	Clinica Family Health - MHP Alpine	1000 ALPINE AVE	BOULDER	CO
CH08165Q	Active	BPS-H80-019394	Clinica Campesina Family Health Services	Clinica Family Health - Westminster	8510 Bryant St Ste 200	Westminster	CO
CH08165R	Active	BPS-H80-008061	Clinica Campesina Family Health Services	Boulder Shelter For The Homeless	4869 Broadway	Boulder	CO
CH08165S	Active	BPS-H80-017939	Clinica Campesina Family Health Services	Clinica Family Health - Lafayette	1735 S Public Rd	Lafayette	CO
CH08165T	Active	BPS-H80-034382	Clinica Campesina Family Health Services	Clinica Family Health - Nederland	80 Big Springs Dr STE 102	Nederland	CO
CH08165U	Active	BPS-H80-034383	Clinica Campesina Family Health Services	Clinica Family Health - Gilpin County	972 Golden Gate Canyon Rd STE 300	Black Hawk	CO
CH08165V	Active	BPS-H80-035042	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Escuela Bilingue Pioneer	101 E Baseline Rd	Lafayette	CO
CH08165W	Active	BPS-H80-035018	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Alicia Sanchez Elementary School	655 Sir Galahad Dr	Lafayette	CO
CH08165X	Active	BPS-H80-034922	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Ryan Elementary School	1405 Centaur Village Dr	Lafayette	CO
CH08165Y	Active	BPS-H80-034977	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Columbine Elementary School	3130 Repplier St	Boulder	CO
CH08165Z	Active	BPS-H80-033550	CLINICA CAMPESINA/FAMILY HEALTH SERVICES	Clinica Family Health - Pecos Administration 3rd Floor	7290 Samuel Dr Ste 312	Denver	CO

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH08165M	BOULDER HEALTH CENTER PHARMACY	5495 ARAPAHOE AVE	SUITE 101	BOULDER	CO	80303-1260	03/11/2009	06/30/2015
CH08165S	GENOA HEALTHCARE LLC	975 NORTH STREET, STE P1		BOULDER	CO	80304	04/01/2023	11/01/2023
CH08165S	GENOA HEALTHCARE LLC	975 NORTH STREET, STE P1		BOULDER	CO	80304	01/01/2025
CH08165AH	GENOA HEALTHCARE LLC	975 NORTH STREET, STE P1		BOULDER	CO	80304	04/01/2025
CH08165S	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/01/2022	10/01/2022
CH08165S	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2021
CH08165S	WAL-MART PHARMACY 10-1231	9901 GRANT ST.		THORNTON	CO	80229	10/01/2021
CH08165C	WAL-MART PHARMACY 10-1231	9901 GRANT ST.		THORNTON	CO	80229	10/01/2024
CH08165AG	WAL-MART PHARMACY 10-1231	9901 GRANT ST.		THORNTON	CO	80229	04/01/2025
CH08165S	WAL-MART PHARMACY 10-3019	850 E 88TH AVE		THORNTON	CO	80229	10/01/2021
CH08165S	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2021
CH081650	WALGREEN ARIZONA DRUG CO		DBA WALGREENS 2400 N WALGREEN STREET	FLAGSTAFF	AZ	86004	04/01/2013	07/06/2015
CH081650	WALGREEN CO	DBA: WALGREENS #05837	4351 E. 104TH AVE	THORNTON	CO	80233	04/01/2013	01/01/2019
CH081650	WALGREEN CO	DBA: WALGREENS #10739	15310 E COLFAX AVE	AURORA	CO	80011	04/01/2013	11/01/2017
CH081650	WALGREEN CO	DBA; WALGREENS #11327	450 KEN PRATT BLVD	LONGMONT	CO	80501	04/01/2013	01/01/2019
CH081650	WALGREEN CO	DBA: WALGREENS	2370 E MAIN STREET	WOODLAND	CA	95776	04/01/2013	08/03/2015
CH08165S	WALGREEN CO	DBA; WALGREENS #11327	450 KEN PRATT BLVD	LONGMONT	CO	80501	01/01/2019
CH08165S	WALGREEN CO	DBA: WALGREENS #05837	4351 E. 104TH AVE	THORNTON	CO	80233	01/01/2019
CH08165AB	WALGREEN CO	DBA: WALGREENS #05837	4351 E. 104TH AVE	THORNTON	CO	80233	07/01/2024
CH08165AC	WALGREEN CO	DBA; WALGREENS #11327	450 KEN PRATT BLVD	LONGMONT	CO	80501	07/01/2025
CH081650	WALGREEN CO.	DBA: WALGREENS # 00356	801 16TH STREET	DENVER	CO	80202	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 01286	655 S BOULDER	LOUISVILLE	CO	80027	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 02482	1830 30TH STREET	BOULDER	CO	80301	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 03266	6395 SHERIDAN BLVD.	ARVADA	CO	80003	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 03298	3080 S BROADWAY	ENGLEWOOD	CO	80113	04/01/2013	11/01/2017
CH081650	WALGREEN CO.	DBA: WALGREENS # 03500	950 S QUEBEC ST	DENVER	CO	80247	04/01/2013	11/12/2015
CH081650	WALGREEN CO.	DBA: WALGREENS # 04025	5190 W. 120TH AVE.	WESTMINSTER	CO	80020	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 04301	2975 FEDERAL	DENVER	CO	80211	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 04468	9970 WADSWORTH PKWY.	WESTMINSTER	CO	80021	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 04667	1601 W. 84TH AVE.	FEDERAL HEIGHTS	CO	80260-5001	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 04894	8799 WASHINGTON ST	THORNTON	CO	80229-4713	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 05644	750 E 120TH AVE	NORTHGLENN	CO	80233	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 06111	309 N US HIGHWAY 287	LAFAYETTE	CO	80026	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 06344	1821 E BRIDGE ST STE A	BRIGHTON	CO	80601-1935	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 06345	2400 EAST MIDWAY BLVD	DENVER	CO	80234	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 06467	1600 COALTON RD	SUPERIOR	CO	80027	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 07006	191 S. MCCASLIN BLVD	SUPERIOR	CO	80027-9690	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 07253	18550 GREEN VALLEY RANCH BLVD	DENVER	CO	80249-6662	04/01/2013	11/01/2017
CH081650	WALGREEN CO.	DBA: WALGREENS # 09570	570 US HIGHWAY 287	BROOMFIELD	CO	80020-1732	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 09598	1041 MAIN STREET	LONGMONT	CO	80501-4302	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 09657	5151 W COLFAX AVE	DENVER	CO	80204-1016	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS #10116	3067 S SHERIDAN BLVD	DENVER	CO	80227-4150	04/01/2013	11/12/2015
CH081650	WALGREEN CO.	DBA: WALGREENS #10118	10337 WASHINGTON ST	THORNTON	CO	80229	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS #11479	2320 MAIN ST.	LONGMONT	CO	80501-1135	04/01/2013	09/01/2015
CH081650	WALGREEN CO.	DBA: WALGREENS #12683	2870 28TH ST	BOULDER	CO	80301	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS #12864	490 ERIE PKWY	ERIE	CO	80516	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 03207	4001 E. 120TH AVENUE	THORNTON	CO	80233	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 04366	4401 WADSWORTH BLVD.	WHEAT RIDGE	CO	80033	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 06213	10390 FEDERAL BLVD	FEDERAL HEIGHTS	CO	80260	04/01/2013	01/01/2019
CH081650	WALGREEN CO.	DBA: WALGREENS # 06552	7211 FEDERAL BLVD	WESTMINSTER	CO	80030	04/01/2013	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 04468	9970 WADSWORTH PKWY.	WESTMINSTER	CO	80021	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS #10118	10337 WASHINGTON ST	THORNTON	CO	80229	01/01/2019	11/07/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS #12864	490 ERIE PKWY	ERIE	CO	80516	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 09570	570 US HIGHWAY 287	BROOMFIELD	CO	80020-1732	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 02482	1830 30TH STREET	BOULDER	CO	80301	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 06345	2400 EAST MIDWAY BLVD	DENVER	CO	80234	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 06213	10390 FEDERAL BLVD	FEDERAL HEIGHTS	CO	80260	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 06467	1600 COALTON RD	SUPERIOR	CO	80027	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 07006	191 S. MCCASLIN BLVD	SUPERIOR	CO	80027-9690	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS #12683	2870 28TH ST	BOULDER	CO	80301	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 04894	8799 WASHINGTON ST	THORNTON	CO	80229-4713	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 04366	4401 WADSWORTH BLVD.	WHEAT RIDGE	CO	80033	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 05644	750 E 120TH AVE	NORTHGLENN	CO	80233	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 06111	309 N US HIGHWAY 287	LAFAYETTE	CO	80026	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 09598	1041 MAIN STREET	LONGMONT	CO	80501-4302	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 04667	1601 W. 84TH AVE.	FEDERAL HEIGHTS	CO	80260-5001	01/01/2019	02/06/2025
CH08165S	WALGREEN CO.	DBA: WALGREENS # 03207	4001 E. 120TH AVENUE	THORNTON	CO	80233	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 01286	655 S BOULDER	LOUISVILLE	CO	80027	01/01/2019	09/29/2022
CH08165S	WALGREEN CO.	DBA: WALGREENS # 06552	7211 FEDERAL BLVD	WESTMINSTER	CO	80030	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 03266	6395 SHERIDAN BLVD.	ARVADA	CO	80003	01/01/2019	02/20/2025
CH08165S	WALGREEN CO.	DBA: WALGREENS # 04025	5190 W. 120TH AVE.	WESTMINSTER	CO	80020	01/01/2019
CH08165S	WALGREEN CO.	DBA: WALGREENS # 04301	2975 FEDERAL	DENVER	CO	80211	01/01/2019
CH08165S	WALGREEN CO.	WALGREENS #19103	4800 BASELINE RD STE E-107	BOULDER	CO	80303-2643	10/01/2021
CH08165S	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21454	4745 ARAPAHOE AVE STE 140	BOULDER	CO	80303	10/01/2021
CH08165S	WALGREEN CO.	WALGREENS #19547	3348 28TH ST	BOULDER	CO	80301	10/01/2021	06/08/2022
CH08165R	WALGREEN CO.	DBA: WALGREENS # 04894	8799 WASHINGTON ST	THORNTON	CO	80229-4713	07/01/2024
CH08165P	WALGREEN CO.	DBA: WALGREENS # 06552	7211 FEDERAL BLVD	WESTMINSTER	CO	80030	07/01/2024
CH08165Q	WALGREEN CO.	DBA: WALGREENS # 04667	1601 W. 84TH AVE.	FEDERAL HEIGHTS	CO	80260-5001	07/01/2024	02/06/2025
CH08165T	WALGREEN CO.	DBA: WALGREENS # 05644	750 E 120TH AVE	NORTHGLENN	CO	80233	07/01/2024
CH08165U	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21454	4745 ARAPAHOE AVE STE 140	BOULDER	CO	80303	07/01/2024
CH08165Z	WALGREEN CO.	DBA: WALGREENS # 02482	1830 30TH STREET	BOULDER	CO	80301	07/01/2024
CH08165X	WALGREEN CO.	DBA: WALGREENS # 06111	309 N US HIGHWAY 287	LAFAYETTE	CO	80026	07/01/2024
CH08165Y	WALGREEN CO.	WALGREENS #19103	4800 BASELINE RD STE E-107	BOULDER	CO	80303-2643	07/01/2024
CH08165V	WALGREEN CO.	DBA: WALGREENS # 06213	10390 FEDERAL BLVD	FEDERAL HEIGHTS	CO	80260	07/01/2024
CH08165AA	WALGREEN CO.	DBA: WALGREENS #12683	2870 28TH ST	BOULDER	CO	80301	07/01/2024
CH08165W	WALGREEN CO.	DBA: WALGREENS # 09598	1041 MAIN STREET	LONGMONT	CO	80501-4302	07/01/2024
CH08165AD	WALGREEN CO.	DBA: WALGREENS # 04025	5190 W. 120TH AVE.	WESTMINSTER	CO	80020	04/01/2025
CH08165AJ	WALGREEN CO.	DBA: WALGREENS # 04301	2975 FEDERAL	DENVER	CO	80211	04/01/2025	04/01/2025
CH08165AE	WALGREEN CO.	DBA: WALGREENS # 06345	2400 EAST MIDWAY BLVD	DENVER	CO	80234	04/01/2025
CH08165AC	WALGREEN CO.	DBA: WALGREENS # 09570	570 US HIGHWAY 287	BROOMFIELD	CO	80020-1732	04/01/2025	04/01/2025
CH08165AF	WALGREEN CO.	DBA: WALGREENS # 03207	4001 E. 120TH AVENUE	THORNTON	CO	80233	04/01/2025
CH08165AJ	WALGREEN CO.	DBA: WALGREENS # 04366	4401 WADSWORTH BLVD.	WHEAT RIDGE	CO	80033	07/01/2025
CH08165S	Walgreens #21397	Walgreens Central Fill #21397	5675 Pecos St. Suite 100	Denver	CO	80221-6655	10/01/2022
CH08165Q	Walgreens #21397	Walgreens Central Fill #21397	5675 Pecos St. Suite 100	Denver	CO	80221-6655	07/01/2025
CH081650	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	07/06/2015
CH081650	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	07/06/2015
CH08165S	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2022
CH08165S	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2022
CH08165S	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2022
CH08165S	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH08165S	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		2/11/2025 3:39:18 PM	2/11/2025 3:39 PM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Smith, Simon CEO Clinica Campesina Family Health Services 3036653036-1003	4/29/2024 12:54 PM
Details	340B ID	Update	New Registration		CH08165W	4/29/2024 12:54 PM
Dates	Participating Approval Date	Update	New Registration		4/29/2024 12:54:39 PM	4/29/2024 12:54 PM
Details	State	Update	New Registration	Pending	Approved	4/29/2024 12:54 PM
Dates	Signed By Date	Update	New Registration		4/10/2024 5:12:40 PM	4/29/2024 12:54 PM
Dates	Start Date	Update	New Registration		7/1/2024 12:00:00 AM	4/29/2024 12:54 PM
Addresses	Main Address	Insert	New Registration		655 Sir Galahad Dr Lafayette, CO 80026-1979	4/10/2024 4:20 PM
Addresses	Billing Address	Insert	New Registration		Clinica Campesina Family Health Services 1735 S Public Rd Lafayette, CO 80026	4/10/2024 4:20 PM
Contacts	Authorizing Official	Insert	New Registration		Smith, Simon CEO Clinica Campesina Family Health Services 3036653036-1003	4/10/2024 4:20 PM
Contacts	Primary Contact	Insert	New Registration		Gonzales, Melinda Pharmacy Director Clinica Campesina Family Health Services 3036653036-2840	4/10/2024 4:20 PM
Details	Assistance Received From Date	Insert	New Registration			4/10/2024 4:20 PM
Details	Assistance Received To Date	Insert	New Registration			4/10/2024 4:20 PM
Details	Last Recertification Date	Insert	New Registration			4/10/2024 4:20 PM
Details	Grant Number	Insert	New Registration		H80CS00690	4/10/2024 4:20 PM
Details	340B ID	Insert	New Registration			4/10/2024 4:20 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/10/2024 4:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/10/2024 4:20 PM
Details	Medicare Provider Number	Insert	New Registration			4/10/2024 4:20 PM
Details	Entity Name	Insert	New Registration		CLINICA CAMPESINA/FAMILY HEALTH SERVICES	4/10/2024 4:20 PM
Details	NOFO Number	Insert	New Registration			4/10/2024 4:20 PM
Details	Program Code	Insert	New Registration		CH	4/10/2024 4:20 PM
Details	Entity Subname	Insert	New Registration		Alicia Sanchez Elementary School	4/10/2024 4:20 PM
Dates	Participating Approval Date	Insert	New Registration			4/10/2024 4:20 PM
Details	State	Insert	New Registration		Pending	4/10/2024 4:20 PM
Dates	Registration Date	Insert	New Registration		4/10/2024 4:20:34 PM	4/10/2024 4:20 PM
Dates	Signed By Date	Insert	New Registration			4/10/2024 4:20 PM
Dates	Start Date	Insert	New Registration			4/10/2024 4:20 PM
Terminations	Termination Comments	Insert	New Registration			4/10/2024 4:20 PM
Terminations	Termination Date	Insert	New Registration			4/10/2024 4:20 PM
Terminations	Termination Effective Date	Insert	New Registration			4/10/2024 4:20 PM
Terminations	Termination Reason	Insert	New Registration			4/10/2024 4:20 PM

340B Drug Pricing Program Database