340B Drug Pricing Program Database


CH09130H CANYONLANDS COMMUNITY HEALTH CARE (Active) - information as of 5/13/2025 10:56:14 PM

Main Details
CANYONLANDS COMMUNITY HEALTH CARE
Canyonlands Healthcare - Clifton
HRSA-Funded Health Center
BPS-H80-007424
CH09130H
H80CS00448


Additional Details
Active
5/17/2006
7/1/2006
5/17/2006
2/11/2025

Contacts

Canyonlands Community Health Care
Christopher Hansen, CEO
(928) 645-6600

Canyonlands Healthcare
Andrew J Lewandowski, Director of Pharmacy
(928) 645-9675 Ext: 2205

Addresses

10-A S. WARD CANYON ROAD
CLIFTON, AZ 85533-0000

CANYONLANDS COMMUNITY HEALTH CARE
PO BOX 1625
PAGE, AZ 86040


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
3/14/2014 Main address updated per EHB/recert03/14/2014
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
AZ432857,0580181134568660,1609966860
UT 1609966860
NV 1609966860
Shipping Addresses

Canyonlands Community Health Care
10-A S. Ward Canyon Road
Clifton, AZ 85533

Canyonlands Community Health Care
2016 W 16th St
Safford, AZ 85546
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH091300ActiveBPS-H80-004454CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Lake Powell467 VISTA AVENUE PAGEAZ
CH09130ATerminatedBPS-H80-002011CANYONLANDS COMMUNITY HEALTH CAREKAIBETO BOARDING SCHOOL CLINICRT 98 DORM STE 4 KAIBETOAZ
CH09130BActiveBPS-H80-011483CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - ChilchinbetoChilchinbeto Chapter House Complex ChilchinbetoAZ
CH09130DActiveBPS-H80-009239CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Beaver Dam3272 E RIO VIRGIN RD LITTLEFIELDAZ
CH09130GActiveBPS-H80-010891CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Safford2016 W 16th St SaffordAZ
CH09130HActiveBPS-H80-007424CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Clifton10-A S. WARD CANYON ROAD CLIFTONAZ
CH09130IActiveBPS-H80-001987CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Duncan227 Main St DuncanAZ
CH09130JActiveBPS-H80-003516CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Urgent Care440 NORTH NAVAJO PAGEAZ
CH09130KActiveBPS-H80-011479CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Globe5860 S. Hospital Dr., Suite 102 GlobeAZ
CH09130LActiveBPS-H80-019571Canyonlands Community Health CareCanyonlands Healthcare - Safford Integrated1615 South 1st Avenue SaffordAZ
CH09130MTerminatedBPS-H80-019547Canyonlands Community Health CareCanyonlands Healthcare - Globe Integrated111 West Blake Street GlobeAZ
CH09130NActiveBPS-H80-032623Canyonlands Community Health CareCanyonlands Healthcare - Mobile Clinic827 Vista Ave. PageAZ
CH09130PActiveBPS-H80-032624Canyonlands Community Health CareCanyonlands Healthcare - Mesquite210 N Sandhill Blvd MesquiteNV
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH091300ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280901/01/2025  
CH091300AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291104/01/2019 01/14/2022
CH091300AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503404/01/2019 01/14/2022
CH091300CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2022  
CH091300CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2022  
CH091300CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2022  
CH091300CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2022  
CH091300CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2022  
CH091300CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2022  
CH091300CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2022  
CH091300CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813307/01/2022  
CH091300CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237407/01/2022  
CH091300CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2022  
CH091300COBRE VALLEY COMMUNITY HOSP5880 S HOSPITAL DR OUTPATIENT PHARMACY
GLOBEAZ85501-944704/01/2016 11/16/2017
CH091300CORAM ALTERNATE SITE SERVICES, INCDBA CORAM CVS/SPECIALTY INFUSION SERVICE 12310 WORLD TRADE DRIVE
SUITE 100
SAN DIEGOCA9212804/01/2025  
CH091300CORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 4310 EAST COTTON CENTER BLVD
SUITE 110
PHOENIXAZ85040-885701/01/2025  
CH091300CORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 2345 WATERS DRIVE
MENDOTA HEIGHTSMN5512004/01/2025  
CH091300CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2022  
CH091300CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2022  
CH091300CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2022  
CH091300CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/01/2022  
CH091300DSW ENTERPRISES INCDBA WALTON DRUG 1520 W THATCHER BLVD
SAFFORDAZ85546-330910/01/2022  
CH091300GERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY #11144 100 NORTH BROAD ST.
GLOBEAZ8550101/01/2020 04/25/2025
CH091300M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312604/01/2019 01/14/2022
CH091300OPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502901/01/2022  
CH091300OPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520410/01/2024  
CH091300OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713001/01/2022  
CH091300OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824901/01/2022  
CH091300OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140101/01/2022  
CH091300OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508501/01/2022  
CH091300OPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660801/01/2022 05/27/2022
CH091300OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983801/01/2022  
CH091300PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310104/01/2019 01/14/2022
CH091300PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2022  
CH091300PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2022  
CH091300PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681307/01/2022  
CH091300PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2022  
CH091300SAFEWAY INCSAFEWAY PHARMACY #0249 P.O.BOX 1346
650 ELM STREET
PAGEAZ8604001/13/2011  
CH091300SAFEWAY INCSAFEWAY PHARMACY #2648 2125 N HIGHWAY 70
THATCHERAZ8555201/01/2015  
CH09130JSAFEWAY INCSAFEWAY PHARMACY #0249 P.O.BOX 1346
650 ELM STREET
PAGEAZ8604007/02/2010  
CH09130GSAFEWAY INCSAFEWAY PHARMACY #2648 2125 N HIGHWAY 70
THATCHERAZ8555207/21/2010  
CH091300SMITH FOOD & DRUG CENTERS INC. DBA SMITH'S PHARMACY #342350 N SANDHILL BLVD
MESQUITENV8902701/01/2015  
CH09130DSMITH FOOD & DRUG CENTERS INC. DBA SMITH'S PHARMACY #342350 N SANDHILL BLVD
MESQUITENV8902707/12/2010  
CH091300SMITH'S FOOD AND DRUG CTR INCDBA FRY'S FOOD AND DRUG #109 2115 U.S. HWY 60
STE 200
MIAMIAZ8553901/01/2020  
CH091300WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2018  
CH091300WAL-MART PHARMACY 10-1149755 SO 20TH AVE
SAFFORDAZ8554601/01/2018 11/02/2017
CH091300WAL-MART PHARMACY 10-1149755 SO 20TH AVE
SAFFORDAZ8554601/01/2018  
CH091300WAL-MART PHARMACY 10-1334100 SOUTH RAGUS ROAD
CLAYPOOLAZ8553201/01/2018 11/02/2017
CH091300WAL-MART PHARMACY 10-1334100 SOUTH RAGUS ROAD
CLAYPOOLAZ8553201/01/2018  
CH091300WAL-MART PHARMACY 10-14421017 WEST HAUL ROAD
PAGEAZ8604001/01/2018 11/02/2017
CH091300WAL-MART PHARMACY 10-14421017 WEST HAUL ROAD
PAGEAZ8604001/01/2018  
CH091300WAL-MART PHARMACY 10-38471120 WEST PIONEER BLVD
MESQUITENV8902701/01/2018 11/02/2017
CH091300WAL-MART PHARMACY 10-38471120 WEST PIONEER BLVD
MESQUITENV8902701/01/2018  
CH091300WAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281901/01/2018 11/02/2017
CH091300WAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281901/01/2018 03/22/2022
CH091300WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/01/2018  
CH091300WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02429 1995 W THATCHER BLVD
SAFFORDAZ85546-331604/01/2014  
CH091300WALGREEN ARIZONA DRUG CO.WALGREENS CENTRAL FILL #21372 120 N 83RD AVE
STE 200
TOLLESONAZ8535310/01/2021  
CH091300WALGREEN CO.DBA: WALGREENS #12646 329 N. SANDHILL BLVD
MESQUITENV89027-472904/01/2014  
CH091300WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528404/01/2014 08/17/2015
CH091300WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/01/2022  
CH091300WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/01/2022  
CH091300WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/01/2022  
CH091300WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275604/01/2023  
CH091300Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616807/01/2024  
CH091300WALTON DRUG OF MORENCIWALTON DRUG 408 BURRO ALLEY
MORENCIAZ8554010/01/2022  
CH091300WESTERN PHARMACY GROUP LLCDBA COMMUNITY MEDICAL CENTER PHARMACY 610 GATEWAY CENTER WAY
SUITES A--E
SAN DIEGOCA9210204/01/2019 01/14/2022
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/5/2024 11:02:16 AM2/11/2025 12:51:28 PM2/11/2025 12:51 PM
DetailsLast Recertification DateUpdateRecertification2/1/2023 7:17:05 PM2/5/2024 11:02:16 AM2/5/2024 11:02 AM
AddressesShipping AddressInsertRecertification Canyonlands Community Health Care 10-A S. Ward Canyon Road Clifton, AZ 855332/1/2023 7:17 PM
AddressesShipping AddressInsertRecertification Canyonlands Community Health Care 2016 W 16th St Safford, AZ 855462/1/2023 7:17 PM
DetailsLast Recertification DateUpdateRecertification2/3/2022 6:32:23 PM2/1/2023 7:17:05 PM2/1/2023 7:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False2/28/2022 7:23 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 4328572/28/2022 7:23 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request AZ2/28/2022 7:23 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 16099668602/28/2022 7:23 PM
Medicaid BillingNPI: StateInsertGroup Change Request AZ2/28/2022 7:23 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 16099668602/28/2022 7:23 PM
Medicaid BillingNPI: StateInsertGroup Change Request UT2/28/2022 7:23 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 16099668602/28/2022 7:23 PM
Medicaid BillingNPI: StateInsertGroup Change Request NV2/28/2022 7:23 PM
DetailsLast Recertification DateUpdateRecertification2/4/2021 6:11:13 PM2/3/2022 6:32:23 PM2/3/2022 6:32 PM
Medicaid BillingNPI: StateUpdateRecertification AZ2/4/2021 6:11 PM
DetailsLast Recertification DateUpdateRecertification1/30/2020 12:04:47 PM2/4/2021 6:11:13 PM2/4/2021 6:11 PM
DetailsLast Recertification DateUpdateRecertification2/5/2019 12:33:11 PM1/30/2020 12:04:47 PM1/30/2020 12:04 PM
DetailsLast Recertification DateUpdateRecertification2/12/2018 11:01:13 AM2/5/2019 12:33:11 PM2/5/2019 12:33 PM
DetailsLast Recertification DateUpdateRecertification2/8/2017 12:00:00 AM2/12/2018 11:01:13 AM2/12/2018 11:01 AM
ContactsAuthorizing OfficialUpdate Hansen, Christopher CEO 9286456600Hansen, Christopher CEO Canyonlands Community Health Care 928645660010/18/2017 12:54 PM
ContactsPrimary ContactUpdate Lewandowski, Andrew Director of Pharmacy 9286459675Lewandowski, Andrew J Director of Pharmacy Canyonlands Healthcare 9286459675-220510/10/2017 11:17 AM
ContactsPrimary ContactUpdate Reed, Mari Director of Operations & Billing 9286459675-5521Lewandowski, Andrew Director of Pharmacy 92864596756/19/2017 11:51 AM
ContactsAuthorizing OfficialUpdate LATHAM, ELIZABETH CEO 9286459675-5507Hansen, Christopher CEO 92864566006/19/2017 11:51 AM
AddressesMain AddressInsert   10-A S. WARD CANYON ROAD CLIFTON, AZ 85533-00002/8/2017 1:31 PM
DetailsLast Recertification DateUpdate 2/29/2016 12:00:00 AM2/8/2017 12:00:00 AM2/8/2017 1:31 PM
AddressesBilling AddressInsert  CANYONLANDS COMMUNITY HEALTH CARE PO BOX 1625 PAGE, AZ 860409/6/2016 10:34 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False9/6/2016 10:34 AM
Medicaid BillingMedicaid: NumberInsert  0580189/6/2016 10:34 AM
Medicaid BillingMedicaid: StateInsert  AZ9/6/2016 10:34 AM
Medicaid BillingNPI: NumberInsert  11345686609/6/2016 10:34 AM
DetailsEntity SubnameUpdate CLIFTON FAMILY HEALTH CENTERCanyonlands Healthcare - Clifton9/6/2016 10:34 AM
ContactsPrimary ContactInsert  Reed, Mari Director of Operations & Billing 9286459675-55219/1/2016 4:47 PM
DetailsLast Recertification DateUpdate 3/5/2015 12:00:00 AM2/29/2016 12:00:00 AM2/29/2016 1:57 PM
ContactsAuthorizing OfficialUpdate LATHAM, ELIZABETH CEO 9286459675-5507LATHAM, ELIZABETH CEO 9286459675-55078/17/2015 2:57 PM
DetailsLast Recertification DateUpdate 3/14/2014 12:00:00 AM3/5/2015 12:00:00 AM3/5/2015 3:13 PM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/14/2014 12:00:00 AM3/14/2014 5:53 AM
DetailsComments PublicInsert  3/14/2014 Main address updated per EHB/recert3/14/2014 5:53 AM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM3/26/2013 10:38 AM
ContactsAuthorizing OfficialInsert  LATHAM, ELIZABETH CEO 9286459675-550712/19/2011 5:13 PM
DetailsLast Recertification DateInsert   5/17/2006 3:13 PM
DetailsGrant NumberInsert  H80CS004485/17/2006 3:13 PM
Details340B IDInsert  CH09130H5/17/2006 3:13 PM
DetailsIs Authorizing Official EHB DataInsert   5/17/2006 3:13 PM
DatesLast Date That 340B Drugs PurchasedInsert   5/17/2006 3:13 PM
DetailsMedicare Provider NumberInsert   5/17/2006 3:13 PM
DetailsEntity NameInsert  CANYONLANDS COMMUNITY HEALTH CARE5/17/2006 3:13 PM
DetailsProgram CodeInsert  CH5/17/2006 3:13 PM
DetailsEntity SubnameInsert  CLIFTON FAMILY HEALTH CENTER5/17/2006 3:13 PM
DatesParticipating Approval DateInsert  5/17/2006 12:00:00 AM5/17/2006 3:13 PM
DetailsStateInsert  Active5/17/2006 3:13 PM
DatesRegistration DateInsert  5/17/2006 12:00:00 AM5/17/2006 3:13 PM
DatesSigned By DateInsert  5/3/2006 12:00:00 AM5/17/2006 3:13 PM
DatesStart DateInsert  7/1/2006 12:00:00 AM5/17/2006 3:13 PM
TerminationsTermination CommentsInsert   5/17/2006 3:13 PM
TerminationsTermination DateInsert   5/17/2006 3:13 PM
TerminationsTermination Effective DateInsert   5/17/2006 3:13 PM
TerminationsTermination ReasonInsert   5/17/2006 3:13 PM