Yes
| CHC26510-00 | Active | BPS-H80-014920 | Southwest Colorado Mental Health Center, Inc. | Cortez Integrated Healthcare | 691 E EMPIRE ST | | CORTEZ | CO |
| CHC26510-01 | Terminated | BPS-H80-013566 | Southwest Colorado Mental Health Center, Inc. | Southwest Colorado Mental Health Center, Inc., dba La Plata Integrated Healthcare | 1970 E. 3rd Ave Unit 1 - Lower Level | | Durango | CO |
| CHC26510-02 | Terminated | BPS-H80-019354 | Southwest Colorado Mental Health Center, Inc. | Axis Health System Oral Health Clinic | 2530 Colorado Ave Unit 1A | | Durango | CO |
| CHC26510-03 | Active | BPS-H80-030804 | Southwest Colorado Mental Health Center, Inc. | Dove Creek Integrated Healthcare | 495 W 4th St | | Dove Creek | CO |
| CHC26510-04 | Active | BPS-H80-031823 | Southwest Colorado Mental Health Center, Inc. | Pagosa Springs Integrated Healthcare | 52 Village Dr | | Pagosa Springs | CO |
| CHC26510-05 | Terminated | BPS-H80-030805 | Southwest Colorado Mental Health Center, Inc. | Cortez Oral Health Clinic | 101 S Maple St Ste B | | Cortez | CO |
| CHC26510-06 | Active | BPS-H80-037703 | SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC | Axis Health System Montrose | 605 Miami Rd | | Montrose | CO |
| CHC26510-07 | Active | BPS-H80-037702 | SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC | Durango Integrated Healthcare | 150 Mercury Village Dr | | Durango | CO |
| CHC26510-08 | Active | BPS-H80-038260 | SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC | Axis Health System - Delta | 107 W 11th St | | Delta | CO |
| CHC26510-09 | Active | BPS-H80-038259 | SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC | Axis Health System - Gunnison | 710 N Taylor St | | Gunnison | CO |
| CHC26510-10 | Active | BPS-H80-038257 | SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC | Axis Health System - Norwood | 1605 Grand Ave | | Norwood | CO |
| CHC26510-11 | Active | BPS-H80-038261 | SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC | Axis Health System - Telluride | 238 E Colorado Ave, #9 | | Telluride | CO |
| CHC26510-12 | Approved | BPS-H80-039162 | SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC | Pagosa Springs Comprehensive Primary Care | 27 Talisman Dr, #B | | Pagosa Springs | CO |
| Contacts | Signed By | Insert | New Registration | | Conrad, Alex
Chief Administrative Officer
Axis Health System
9703352233 | 5/6/2025 1:00 PM |
| Details | 340B ID | Update | New Registration | | CHC26510-12 | 5/6/2025 1:00 PM |
| Dates | Participating Approval Date | Update | New Registration | | 5/6/2025 1:00:36 PM | 5/6/2025 1:00 PM |
| Details | State | Update | New Registration | Pending | Approved | 5/6/2025 1:00 PM |
| Dates | Signed By Date | Update | New Registration | | 4/11/2025 3:58:31 PM | 5/6/2025 1:00 PM |
| Dates | Start Date | Update | New Registration | | 7/1/2025 12:00:00 AM | 5/6/2025 1:00 PM |
| Addresses | Main Address | Insert | New Registration | |
27 Talisman Dr, #B
Pagosa Springs, CO 81147-9377 | 4/11/2025 3:56 PM |
| Addresses | Billing Address | Insert | New Registration | | Axis Health System
150 Mercury Village Dr
Durango, CO 81301 | 4/11/2025 3:56 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1619761137 | 4/11/2025 3:56 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CO | 4/11/2025 3:56 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Conrad, Alex
Chief Administrative Officer
Axis Health System
9703352233 | 4/11/2025 3:56 PM |
| Contacts | Primary Contact | Insert | New Registration | | Shumway, Joshua
Director of Pharmacy
Southwest Colorado Mental Health Center Inc dba Axis Health System
9709039423 | 4/11/2025 3:56 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Details | Grant Number | Insert | New Registration | | H80CS26510 | 4/11/2025 3:56 PM |
| Details | 340B ID | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Details | Entity Name | Insert | New Registration | | SOUTHWEST COLORADO MENTAL HEALTH CENTER, INC | 4/11/2025 3:56 PM |
| Details | NOFO Number | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Details | Program Code | Insert | New Registration | | CH | 4/11/2025 3:56 PM |
| Details | Entity Subname | Insert | New Registration | | Pagosa Springs Comprehensive Primary Care | 4/11/2025 3:56 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Details | State | Insert | New Registration | | Pending | 4/11/2025 3:56 PM |
| Dates | Registration Date | Insert | New Registration | | 4/11/2025 3:56:36 PM | 4/11/2025 3:56 PM |
| Dates | Signed By Date | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Dates | Start Date | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Terminations | Termination Date | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 4/11/2025 3:56 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 4/11/2025 3:56 PM |