Covered Entity Details

CHC08229-09 First Nations Community Health Source Inc (Approved) - information as of 5/13/2025 1:27:36 AM

Main Details

Name

First Nations Community Health Source Inc

Subdivision Name

FNCH Integrated Care Mobile Medical Van

Type

HRSA-Funded Health Center

Site ID

BPS-H80-038517

340B ID

CHC08229-09

Grant Number

H80CS08229

Additional Details

Current Program Status

Approved

Registration Date

4/1/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/2/2025

Last Recertification Date

Contacts

Authorizing Official

First Nations Community HealthSource
Linda Son-Stone, CEO
(505) 262-6546

Primary Contact

First Nations Community HealthSource
Earla Begay, Interim CFO
(505) 262-2481

Addresses

Street Address

5608 Zuni Rd SE
Albuquerque, NM 87108-2926

Billing Address
Same as Street Address

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?
Yes

State	Medicaid Number	NPI Number
NM	00046912	1407676679

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
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC08229-00	Active	BPS-H80-005607	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	First Nations Community HealthSource	5608 Zuni Rd SE	Albuquerque	NM
CHC08229-01	Active	BPS-H80-012980	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	FNCH-Truman Health Center	625 Truman St NE	Albuquerque	NM
CHC08229-02	Active	BPS-H80-029406	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	Native American Community Academy High School	940 University Blvd SE	Albuquerque	NM
CHC08229-03	Active	BPS-H80-020876	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	Wilson Middle School	138 Cardenas Drive SE	Albuquerque	NM
CHC08229-04	Active	BPS-H80-020878	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	Native American Community Academy School Based Health Center	1000 Indian School Rd NW	Albuquerque	NM
CHC08229-05	Active	BPS-H80-021944	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	Emerson Elementary School	620 Georgia Street SE	Albuquerque	NM
CHC08229-06	Active	BPS-H80-020872	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	Grant Middle School	1111 Easterday Dr NE	Albuquerque	NM
CHC08229-07	Active	BPS-H80-029889	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	First Nations Community HealthSource Inc Central Avenue Health Center	7317 Central Ave NE	Albuquerque	NM
CHC08229-08	Terminated	BPS-H80-020946	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	FNCH Outpatient Services	634 Manzano Street NE	Albuquerque	NM
CHC08229-09	Approved	BPS-H80-038517	First Nations Community Health Source Inc	FNCH Integrated Care Mobile Medical Van	5608 Zuni Rd SE	Albuquerque	NM
CHC08229-10	Approved	BPS-H80-033448	First Nations Community Health Source Inc	All Nations Wellness Center	6416 Zuni Rd SE	Albuquerque	NM
CHC08229-11	Approved	BPS-H80-036341	First Nations Community Health Source Inc	FNCH Vision Clinic	505 Madeira SE	Albuquerque	NM

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC08229-00	PHIL'S PHARMACY		5510 LOMAS N.E.	ALBUQUERQUE	NM	87110	01/01/2015	04/03/2017
CHC08229-01	PHIL'S PHARMACY		5510 LOMAS N.E.	ALBUQUERQUE	NM	87110	01/01/2015	06/22/2017
CHC08229-00	SMITH'S FOOD & DRUG CTRS	SMITH'S PHARMACY #496	3701 CONSTITUTION NE	ALBUQUERQUE	NM	87110	01/01/2015	04/03/2017
CHC08229-01	SMITH'S FOOD & DRUG CTRS	SMITH'S PHARMACY #496	3701 CONSTITUTION NE	ALBUQUERQUE	NM	87110	01/01/2015	06/22/2017
CHC08229-00	SMITHS FOOD & DRUG CTRS	DBA SMITH'S FOOD & DRUG #446	6001 LOMAS NE	ALBUQUERQUE	NM	87110	01/01/2015	04/03/2017
CHC08229-01	SMITHS FOOD & DRUG CTRS	DBA SMITH'S FOOD & DRUG #446	6001 LOMAS NE	ALBUQUERQUE	NM	87110	01/01/2015	06/22/2017
CHC08229-00	WAL-MART PHARMACY 10-0831	301 SAN MATEO BLV SE		ALBUQUERQUE	NM	87108	01/01/2015	09/03/2015
CHC08229-01	WAL-MART PHARMACY 10-0831	301 SAN MATEO BLV SE		ALBUQUERQUE	NM	87108	01/01/2015	09/07/2016
CHC08229-00	WALGREEN CO.	DBA: WALGREENS #11959	5201 CENTRAL AVE. NE	ALBUQUERQUE	NM	87108-1328	01/01/2015	09/03/2015
CHC08229-01	WALGREEN CO.	DBA: WALGREENS #11959	5201 CENTRAL AVE. NE	ALBUQUERQUE	NM	87108-1328	01/01/2015	09/07/2016
CHC08229-00	WALGREEN HASTINGS CO.	DBA: WALGREENS # 04649	3501 LOMAS BLVD. NE	ALBUQUERQUE	NM	87106	01/01/2015	09/03/2015
CHC08229-01	WALGREEN HASTINGS CO.	DBA: WALGREENS # 04649	3501 LOMAS BLVD. NE	ALBUQUERQUE	NM	87106	01/01/2015	09/07/2016

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Son-Stone, Linda CEO First Nations Community HealthSource 5052626546	4/2/2025 8:37 AM
Details	340B ID	Update	New Registration		CHC08229-09	4/2/2025 8:37 AM
Dates	Participating Approval Date	Update	New Registration		4/2/2025 8:37:19 AM	4/2/2025 8:37 AM
Details	State	Update	New Registration	Pending	Approved	4/2/2025 8:37 AM
Dates	Signed By Date	Update	New Registration		4/1/2025 10:55:20 PM	4/2/2025 8:37 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/2/2025 8:37 AM
Addresses	Main Address	Insert	New Registration		5608 Zuni Rd SE Albuquerque, NM 87108-2926	4/1/2025 10:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/1/2025 10:55 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		00046912	4/1/2025 10:55 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NM	4/1/2025 10:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1407676679	4/1/2025 10:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		NM	4/1/2025 10:55 PM
Contacts	Authorizing Official	Insert	New Registration		Son-Stone, Linda CEO First Nations Community HealthSource 5052626546	4/1/2025 10:55 PM
Contacts	Primary Contact	Insert	New Registration		Begay, Earla Interim CFO First Nations Community HealthSource 5052622481	4/1/2025 10:55 PM
Details	Assistance Received From Date	Insert	New Registration			4/1/2025 10:55 PM
Details	Assistance Received To Date	Insert	New Registration			4/1/2025 10:55 PM
Details	Last Recertification Date	Insert	New Registration			4/1/2025 10:55 PM
Details	Grant Number	Insert	New Registration		H80CS08229	4/1/2025 10:55 PM
Details	340B ID	Insert	New Registration			4/1/2025 10:55 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/1/2025 10:55 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/1/2025 10:55 PM
Details	Medicare Provider Number	Insert	New Registration			4/1/2025 10:55 PM
Details	Entity Name	Insert	New Registration		First Nations Community Health Source Inc	4/1/2025 10:55 PM
Details	NOFO Number	Insert	New Registration			4/1/2025 10:55 PM
Details	Program Code	Insert	New Registration		CH	4/1/2025 10:55 PM
Details	Entity Subname	Insert	New Registration		FNCH Integrated Care Mobile Medical Van	4/1/2025 10:55 PM
Dates	Participating Approval Date	Insert	New Registration			4/1/2025 10:55 PM
Details	State	Insert	New Registration		Pending	4/1/2025 10:55 PM
Dates	Registration Date	Insert	New Registration		4/1/2025 10:55:20 PM	4/1/2025 10:55 PM
Dates	Signed By Date	Insert	New Registration			4/1/2025 10:55 PM
Dates	Start Date	Insert	New Registration			4/1/2025 10:55 PM
Terminations	Termination Comments	Insert	New Registration			4/1/2025 10:55 PM
Terminations	Termination Date	Insert	New Registration			4/1/2025 10:55 PM
Terminations	Termination Effective Date	Insert	New Registration			4/1/2025 10:55 PM
Terminations	Termination Reason	Insert	New Registration			4/1/2025 10:55 PM

340B Drug Pricing Program Database