340B Drug Pricing Program Database


PED063301-00 Children's Hospital Colorado (Active) - information as of 5/9/2025 10:45:57 PM

Main Details
Children's Hospital Colorado
Children's Hospital
No
PED063301-00
063301


Additional Details
Active
8/22/2010
9/9/2010
9/9/2010
9/4/2024

Contacts

Children's Hospital Colorado
Casey Dugan, Vice President of Pharmacy Services
(720) 777-5683

Children's Hospital Colorado
Ricardo Alexis Laremont, Pharmacy 340B Program Manager
(720) 777-8899

Addresses

13123 EAST 16TH AVENUE
AURORA, CO 80045

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CO050020431336245828,1851942023,1376104125,1740991298,1720243348,1881304004,1023867397
Shipping Addresses

Children's Hospital Colorado
13123 E 16th Avenue
Aurora, CO 80045

Children's Hospital Colorado
BMT Laboratory
13123 E 16TH AVENUE
LOWER LEVEL
AURORA, CO 80045

Health Pavilion Specialty Pharmacy
860 North Potomac Circle
Aurora, CO 80011

CHCO North Campus PHCY
469 STATE HWY 7 SUITE NOIP268
Broomfield, CO 80023

Children's Hospital Colorado Outpatient Pharmacy at Anschutz Medical Campus
13123 E 16th Avenue
Aurora, CO 80045
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/26/201710/01/2017  10/01/2017
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/26/201710/01/2017  10/01/2017
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/26/201710/01/2017  10/01/2017
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/26/201710/01/2017 08/01/202309/29/2023
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/26/201710/01/2017 01/01/201901/10/2019
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/26/201710/01/2017 01/01/201901/10/2019
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/13/202310/01/2023  10/01/2023
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/13/202310/01/2023  10/01/2023
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607510/13/202301/01/2024  01/01/2024
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280907/26/201710/01/2017 09/20/202211/01/2022
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/05/202407/01/2024  07/01/2024
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/26/201710/01/2017  10/01/2017
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/26/201710/01/2017  10/01/2017
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/05/202407/01/2024  07/01/2024
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/05/202407/01/2024  07/01/2024
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/05/202407/01/2024  07/01/2024
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/05/202407/01/2024  07/01/2024
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/05/202407/01/2024  07/01/2024
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/26/201710/01/2017  10/01/2017
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/05/202407/01/2024  07/01/2024
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/05/202407/01/2024  07/01/2024
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503304/18/201807/01/2018  04/18/2018
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268301/17/201704/01/2017 06/30/201807/17/2018
Contract DetailDIPLOMAT SPECIALTY PHARMACY OF SOUTHERNDIPLOMAT SPECIALTY PHARMACY 1809 EXCISE AVENUE
SUITE 204-208 		ONTARIOCA9176101/17/201704/01/2017 06/30/201807/17/2018
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191304/15/202207/01/2022  07/01/2022
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260104/05/202407/01/2024  07/01/2024
Contract DetailOPTUM INFUSION SERVICES 302, LLC8720 S 114TH ST STE 106
LA VISTANE68128-558504/15/202207/01/2022  07/01/2022
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/15/202207/01/2022  07/01/2022
Contract DetailOPTUM INFUSION SERVICES 308, LLC6547 S RACINE CIR STE 300
CENTENNIALCO8011104/15/202207/01/2022  07/01/2022
Contract DetailOPTUM INFUSION SERVICES 308, LLC485 N JUNIPER DR STE 2
CHANDLERAZ8522610/17/202201/01/2023  01/01/2023
Contract DetailOPTUM INFUSION SERVICES 401, LLC4610 NORTHGATE BLVD. STE. 130
SACRAMENTOCA95834-115407/11/202210/01/2022  10/01/2022
Contract DetailOPTUM INFUSION SERVICES 500, INC.4900 RIVERGRADE RD STE E120
IRWINDALECA91706-141904/15/202207/01/2022 08/02/202208/02/2022
Contract DetailOPTUM INFUSION SERVICES 550, LLC9045 E PIMA CENTER PKWY STE 1
SCOTTSDALEAZ85258-462104/15/202207/01/2022 10/17/202210/17/2022
Contract DetailOPTUM INFUSION SERVICES 550, LLC7167 E. KEMPER RD.
CINCINNATIOH4524904/15/202207/01/2022  07/01/2022
Contract DetailOPTUM INFUSION SERVICES 550, LLC10607 & 10611 AURORA AVE.
URBANDALEIA5032204/15/202207/01/2022  07/01/2022
Contract DetailOPTUM INFUSION SERVICES 550, LLC1819 ASTON AVE STE 104
CARLSBADCA9200807/11/202210/01/2022  10/01/2022
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502904/15/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/15/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520404/05/202407/01/2024  07/01/2024
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/15/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824904/15/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970504/15/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/15/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140104/15/202207/01/2022  07/01/2022
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660804/15/202207/01/2022 08/02/202208/02/2022
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983804/15/202207/01/2022  07/01/2022
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999204/18/201807/01/2018 07/13/202307/13/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/26/201710/01/2017  10/01/2017
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #102 2101 N URSULA STREET UNIT 35
AURORACO80045-742604/15/201907/01/2019  07/01/2019
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/05/202407/01/2024  07/01/2024
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/05/202407/01/2024  07/01/2024
Contract DetailWALGREEN CODBA: WALGREENS #07955 13611 COLORADO BLVD
THORNTONCO8060204/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CODBA: WALGREENS #11615 24250 E. SMOKY HILL RD
AURORACO8001604/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CODBA: WALGREENS #10455 2281 E. ARAPAHOE RD
CENTENNIALCO8012210/09/202001/01/2021  01/01/2021
Contract DetailWALGREEN CODBA: WALGREENS #07837 7370 LAGAE RD
CASTLE PINESCO8010810/09/202001/01/2021  01/01/2021
Contract DetailWALGREEN CODBA: WALGREENS #10739 15310 E COLFAX AVE
AURORACO8001107/06/202210/01/2022  10/01/2022
Contract DetailWALGREEN CODBA: WALGREENS #12366 360 S COLORADO BLVD
GLENDALECO8024607/06/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07138 13143 S PARKER RD
PARKERCO8013404/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04307 12051 E MISSISSIPPI AVE
AURORACO8001204/18/201807/01/2018 02/19/202502/20/2025
Contract DetailWALGREEN CO.DBA: WALGREENS # 07581 7311 E 29TH DRIVE
DENVERCO8023804/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 07253 18550 GREEN VALLEY RANCH BLVD
DENVERCO80249-666204/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04952 9141 S. BROADWAY
HIGHLANDS RANCHCO8012904/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 05261 19028 LINCOLN AVE
PARKERCO8013404/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03510 7496 S SIMMS ST
LITTLETONCO8012704/18/201807/01/2018 04/02/202504/03/2025
Contract DetailWALGREEN CO.DBA: WALGREENS # 03207 4001 E. 120TH AVENUE
THORNTONCO8023304/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16516 2608 E COLFAX AVE
DENVERCO8020604/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #12864 490 ERIE PKWY
ERIECO8051604/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 03190 1111 S COLORADO BLVD
DENVERCO80246-290104/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 06514 14 E ALLEN ST
CASTLE ROCKCO8010804/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS #11448 13123 EAST 16TH AVE
AURORACO80045-710604/18/201807/01/2018 11/15/202211/15/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 04470 20051 E SMOKY HILL RD
CENTENNIALCO8001504/18/201807/01/2018  04/18/2018
Contract DetailWALGREEN CO.DBA: WALGREENS # 04025 5190 W. 120TH AVE.
WESTMINSTERCO8002010/09/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 02641 4175 E WILDCAT RESERVE PKWY
HIGHLANDS RANCHCO8012610/09/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 05538 6650 TIMBERLINE ROAD
HIGHLANDS RANCHCO8013010/09/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 06344 1821 E BRIDGE ST
STE A 		BRIGHTONCO80601-193510/09/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS #12422 15310 E 104TH AVE
COMMERCE CITYCO8002210/09/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 06826 6390 MCINTYRE PKWY
ARVADACO8040310/09/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 04610 18461 E HAMPDEN AVE
AURORACO8001307/06/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07021 18620 E ILIFF AVE
AURORACO80013-599507/06/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 04469 15301 E. MISSISSIPPI AVE.
AURORACO8001707/06/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 03655 10501 E. COLFAX AVE.
AURORACO8001007/06/202210/01/2022 11/13/202411/14/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 06987 355 S WILCOX ST
CASTLE ROCKCO80104-191407/06/202210/01/2022  10/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 10704 8959 E DRY CREEK RD
CENTENNIALCO80112-276507/06/202210/01/2022  10/01/2022
Contract DetailWalgreens #21397Walgreens Central Fill #21397 5675 Pecos St.
Suite 100 		DenverCO80221-665507/13/202310/01/2023  10/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/18/201807/01/2018 10/05/202110/06/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/18/201807/01/2018  04/18/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/18/201807/01/2018  04/18/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/18/201807/01/2018  04/18/2018
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
PED063301-01ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - North Campus Urgent Care469 State Highway 7BroomfieldCOActive
PED063301-02ChildPEDChildren's Hospital ColoradoUrgent Care Uptown Denver1830 Franklin StreetDenverCOActive
PED063301-03ChildPEDTHE CHILDREN'S HOSPITAL ASSOCIATIONChildren's Hospital Colorado - Littleton Oncology Clinic13123 East 16th AvenueAuroraCOTerminated
PED063301-04ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - Parker Physical Therapy19284 Cottonwood DrParkerCOActive
PED063301-05ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - Broomfield Physical Therapy8401 Arista PlaceBroomfieldCOActive
PED063301-06ChildPEDTHE CHILDREN'S HOSPITAL ASSOCIATIONChildren's Hospital Colorado - Memorial Printers Park Peds PT- Outpatient175 S Union BlvdColorado SpringsCOTerminated
PED063301-07ChildPEDTHE CHILDREN'S HOSPITAL ASSOCIATIONChildren's Hospital Colorado - Pueblo Speech Pathology704 Fortino BlvdPuebloCOTerminated
PED063301-08ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - KidStreet Therapy Care860 North Potomac CircleAuroraCOActive
PED063301-09ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - Centennial Orthopedic Care9094 E Mineral AveCentennialCOActive
PED063301-10ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - Village Pavilion 3rd Floor Clinics860 N Potomac CircleAuroraCOTerminated
PED063301-100ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - North Campus Genetics - North Campus Genetics469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-101ChildPEDChildren's Hospital ColoradoSoutheast Aurora Genetics23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-102ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Campus Lifestyle Medicine - North Campus Lifestyle Medicine469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-103ChildPEDChildren's Hospital ColoradoSoutheast Aurora ENT23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-104ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - North Campus Plastic Surgery - North Campus Plastic Surgery469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-105ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - South Campus Nephrology Clinic - South Campus Nephrology Clinic1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-106ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Campus Nephrology Clinic - North Campus Nephrology Clinic469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-107ChildPEDChildren's Hospital ColoradoSoutheast Aurora Endocrinology23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-108ChildPEDChildren's Hospital ColoradoSoutheast Aurora Neurology23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-109ChildPEDChildren's Hospital ColoradoSoutheast Aurora Gastro23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-11ChildPEDChildren's Hospital ColoradoSoutheast Aurora Clinics23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-110ChildPEDChildren's Hospital ColoradoSoutheast Aurora Urology23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-111ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - Maternal Fetal Care North - Maternal Fetal Care North469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-112ChildPEDChildren's Hospital ColoradoSoutheast Aurora Gynecology23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-113ChildPEDChildren's Hospital ColoradoSoutheast Aurora Urgent Care23770 E. Smoky Hill RdAuroraCOActive
PED063301-12ChildPEDTHE CHILDREN'S HOSPITAL ASSOCIATIONChildren's Hospital Colorado - Centennial OP Specialty Care13123 East 16th AvenueAuroraCOTerminated
PED063301-13ChildPEDTHE CHILDREN'S HOSPITAL ASSOCIATIONChildren's Hospital Colorado - Briargate COS OP Specialty Care4125 Briargate ParkwayColorado SpringsCOTerminated
PED063301-14ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - Urgent Care Wheat Ridge3455 Lutheran PkwyWheat RidgeCOActive
PED063301-15ChildPEDTHE CHILDREN'S HOSPITAL ASSOCIATIONChildren's Hospital Colorado - Littleton Physical Therapy151 West County Line RdLittletonCOTerminated
PED063301-16ChildPEDTHE CHILDREN'S HOSPITAL ASSOCIATIONChildren's Hospital Colorado - Briargate COS Orthopedic Care4125 Briargate ParkwayColorado SpringsCOTerminated
PED063301-17ChildPEDTHE CHILDREN'S HOSPITAL ASSOCIATIONChildren's Hospital Colorado - Briargate Oncology Clinic4125 Briargate ParkwayColorado SpringsCOTerminated
PED063301-18ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - Uptown Clinics1830 Franklin St.DenverCOActive
PED063301-19ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado / Uptown Orthopedic Care1830 Franklin StDenverCOActive
PED063301-20ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - North Campus OP Specialty Care469 State Highway 7BroomfieldCOActive
PED063301-21ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - North Campus Orthopedic Care469 State Highway 7BroomfieldCOActive
PED063301-22ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - North Campus Sports Therapy469 State Highway 7BroomfieldCOActive
PED063301-23ChildPEDChildren's Hospital ColoradoSoutheast Aurora Orthopedic Care23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-24ChildPEDChildren's Hospital ColoradoSoutheast Aurora Sports Therapy23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-25ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - South Campus CCBD1811 Plaza DrHighlands RanchCOActive
PED063301-26ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - South Campus Level 4 OP Specialty1811 Plaza DrHighlands RanchCOTerminated
PED063301-27ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - South Campus Level 3 OP Specialty1811 Plaza DrHighlands RanchCOActive
PED063301-28ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - South Campus Radiology1811 Plaza DrHighlands RanchCOActive
PED063301-29ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - South Campus Sports Therapy1811 Plaza DrHighlands RanchCOActive
PED063301-30ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - South Campus Surgery1811 Plaza DrHighlands RanchCOActive
PED063301-31ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - South Campus Urgent Care1811 Plaza DrHighlands RanchCOActive
PED063301-32ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - Outpatient Specialty Care Wheat Ridge3455 Lutheran PkwyWheat RidgeCOActive
PED063301-33ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - Wheat Ridge Orthopedic Care3455 Lutheran PkwyWheat RidgeCOActive
PED063301-34ChildPEDTHE CHILDREN'S HOSPITAL ASSOCIATIONCHILDRENS HOSPITAL COLORADO / Wheatridge Gastro469 WEST STATE HIGHWAY 7BROOMFIELDCOTerminated
PED063301-35ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / Wheat Ridge Ado Family3455 LUTHERAN PARKWAY SUITE 230WHEAT RIDGECOActive
PED063301-36ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / Wheat Ridge ENT3455 Lutheran PkwyWHEAT RIDGECOActive
PED063301-37ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / North Campus Allergy469 State Highway 7BROOMFIELDCOActive
PED063301-38ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / North Campus ENT469 State Highway 7BROOMFIELDCOActive
PED063301-39ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / North Campus Dermatology469 WEST STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-40ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / Uptown Rehab Clinic1830 FRANKLIN STREETDENVERCOActive
PED063301-41ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / Uptown ENT1830 Franklin StreetDENVERCOActive
PED063301-42ChildPEDChildren's Hospital ColoradoSoutheast Aurora Allergy23770 E. Smoky Hill Rd.AuroraCOActive
PED063301-43ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado / Child Health Clinic HP860 N Potomac CircleAuroraCOActive
PED063301-44ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado / CO Ado Maternity PR HP860 N Potomac CircleAuroraCOActive
PED063301-45ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado / Ado Medicine Clinic HP860 N Potomac CircleAuroraCOActive
PED063301-46ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado / Eye Clinic HP860 N Potomac CircleAuroraCOActive
PED063301-47ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado / Young Mothers HP860 N Potomac CircleAuroraCOActive
PED063301-48ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado / Ado Family Planning HP860 N Potomac CircleAuroraCOActive
PED063301-49ChildPEDTHE CHILDREN'S HOSPITAL ASSOCIATIONCHILDRENS HOSPITAL COLORADO / Broomfield OP Specialty Care8401 ARISTA PLACEBROOMFIELDCOTerminated
PED063301-50ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / Broomfield Rehab Psych8401 ARISTA PLACEBROOMFIELDCOActive
PED063301-51ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Eye Clinic1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-52ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Rehab Clinic1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-53ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Urology1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-54ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Endo1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-55ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South BDC1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-56ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Gynecology1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-57ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Dermatology1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-58ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Gastro1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-59ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Ado Family1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-60ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Allergy1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-61ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South ENT1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-62ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Campus Rehab Psych1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-63ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Ortho1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-64ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Neurology1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-65ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO / South Campus Cardiology1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-66ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - Parker Emergency Department9395 CROWN CREST BOULEVARDPARKERCOTerminated
PED063301-67ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - Uptown Sleep Lab1830 N FRANKLIN STDENVERCOActive
PED063301-68ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Campus Pediatric Surgery Clinic469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-69ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - Uptown Gastro1830 N FRANKLIN STDENVERCOActive
PED063301-70ChildPEDChildren's Hospital ColoradoCHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion Wellness Center860 N POTOMAC CIRCLEAURORACOActive
PED063301-71ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Pulmonary469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-72ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Campus Radiology469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-73ChildPEDChildren's Hospital ColoradoCHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion Outpatient Physical Therapy860 N POTOMAC CIRCLEAURORACOActive
PED063301-74ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - Uptown Cardiology Clinic1830 N FRANKLIN STDENVERCOActive
PED063301-75ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - Uptown Allergy1830 N FRANKLIN STDENVERCOActive
PED063301-76ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Urology469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-77ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Campus Rehab Clinic469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-78ChildPEDChildren's Hospital ColoradoCHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion TRUE Center860 N POTOMAC CIRCLEAURORACOActive
PED063301-79ChildPEDChildren's Hospital ColoradoCHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion Orthopedic Clinic860 N POTOMAC CIRCLEAURORACOActive
PED063301-80ChildPEDChildren's Hospital ColoradoCHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion Eye Care CO860 N POTOMAC CIRCLEAURORACOActive
PED063301-81ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - Uptown Endocrinology1830 N FRANKLIN STDENVERCOActive
PED063301-82ChildPEDChildren's Hospital ColoradoCHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion Pulmonary Clinic860 N POTOMAC CIRCLEAURORACOActive
PED063301-83ChildPEDChildren's Hospital ColoradoCHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion CHIP Youth Program860 N POTOMAC CIRCLEAURORACOActive
PED063301-84ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Campus Endocrinology469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-85ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - South Pulmonary1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-86ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Cardiology469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-87ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - Wheat Ridge Cardiology3455 LUTHERAN PKWYWHEAT RIDGECOActive
PED063301-88ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - Wheat Ridge Dermatology3455 LUTHERAN PKWYWHEAT RIDGECOActive
PED063301-89ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - Wheat Ridge Endocrinology3455 LUTHERAN PKWYWHEAT RIDGECOActive
PED063301-90ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Campus CCBD Infusion469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-91ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - Wheat Ridge Gastro3455 LUTHERAN PKWYWHEAT RIDGECOActive
PED063301-92ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - South Rheumatology1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-93ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Gastro469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-94ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - South Campus Sleep Lab1811 PLAZA DRIVEHIGHLANDS RANCHCOActive
PED063301-95ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - North Campus Eye Clinic469 State Highway 7BroomfieldCOActive
PED063301-96ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - North Campus Rheumatology469 State Highway 7BroomfieldCOActive
PED063301-97ChildPEDChildren's Hospital ColoradoChildren's Hospital Colorado - North Campus Gynecology469 State Highway 7BroomfieldCOActive
PED063301-98ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Campus Neurology469 STATE HIGHWAY 7BROOMFIELDCOActive
PED063301-99ChildPEDChildren's Hospital ColoradoCHILDRENS HOSPITAL COLORADO - North Campus Adolescent Family Planning469 STATE HIGHWAY 7BROOMFIELDCOActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/29/2023 9:00:57 PM9/4/2024 5:08:56 PM9/4/2024 5:08 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10238673975/21/2024 7:24 PM
Medicaid BillingNPI: StateInsertGroup Change Request CO5/21/2024 7:24 PM
Medicaid BillingNPI: NumberInsertChange Request 18813040042/16/2024 6:14 PM
Medicaid BillingNPI: StateInsertChange Request CO2/16/2024 6:14 PM
Medicaid BillingNPI: NumberInsertChange Request 172024334812/8/2023 4:46 PM
Medicaid BillingNPI: StateInsertChange Request CO12/8/2023 4:46 PM
DetailsLast Recertification DateUpdateRecertification9/12/2022 1:04:52 PM8/29/2023 9:00:57 PM8/29/2023 9:00 PM
Medicaid BillingNPI: NumberInsertChange Request 17409912986/7/2023 3:20 PM
Medicaid BillingNPI: StateInsertChange Request CO6/7/2023 3:20 PM
AddressesShipping AddressUpdateChange RequestChildren's Hospital Colorado Outpatient Pharmacy 13123 E 16th Avenue, Box 710 ROOM A1699 Aurora, CO 80045Children's Hospital Colorado Outpatient Pharmacy at Anschutz Medical Campus 13123 E 16th Avenue Aurora, CO 800452/20/2023 8:01 AM
AddressesShipping AddressUpdateChange RequestChildren's Hospital Colorado Outpatient Pharmacy 13123 E 16th Avenue, Box 710 ROOM A6099 Aurora, CO 80045Children's Hospital Colorado Outpatient Pharmacy 13123 E 16th Avenue, Box 710 ROOM A1699 Aurora, CO 800452/16/2023 11:17 AM
AddressesShipping AddressInsertChange Request Children's Hospital Colorado Outpatient Pharmacy 13123 E 16th Avenue, Box 710 ROOM A6099 Aurora, CO 8004512/31/2022 7:58 AM
DetailsLast Recertification DateUpdateRecertification9/8/2021 7:01:17 AM9/12/2022 1:04:52 PM9/12/2022 1:04 PM
Medicaid BillingNPI: NumberInsertChange Request 137610412512/6/2021 2:51 PM
Medicaid BillingNPI: StateInsertChange Request CO12/6/2021 2:51 PM
DetailsLast Recertification DateUpdateRecertification9/10/2020 3:04:59 PM9/8/2021 7:01:17 AM9/8/2021 7:01 AM
ContactsPrimary ContactUpdateProfile Change RequestLaremont, Ricardo Alexis Pharmacy 340B Coordinator Children's Hospital Colorado 7207778899Laremont, Ricardo Alexis Pharmacy 340B Program Manager Children's Hospital Colorado 72077788996/23/2021 11:54 AM
Medicaid BillingNPI: NumberDeleteRecertification1851942023 ( ) 9/10/2020 3:04 PM
Medicaid BillingNPI: NumberInsertRecertification 13362458289/10/2020 3:04 PM
Medicaid BillingNPI: StateInsertRecertification CO9/10/2020 3:04 PM
Medicaid BillingNPI: NumberInsertRecertification 18519420239/10/2020 3:04 PM
Medicaid BillingNPI: StateInsertRecertification CO9/10/2020 3:04 PM
Medicaid BillingNPI: NumberDeleteRecertification1336245828 ( ) 9/10/2020 3:04 PM
DetailsLast Recertification DateUpdateRecertification9/15/2019 8:39:46 AM9/10/2020 3:04:59 PM9/10/2020 3:04 PM
AddressesShipping AddressInsertChange Request CHCO North Campus PHCY 469 STATE HWY 7 SUITE NOIP268 Broomfield, CO 800233/9/2020 5:17 PM
ContactsPrimary ContactUpdateProfile Change RequestLaremont, Ricardo Alexis Pharmacy 340B Coordinator The Childrens Hospital Association 7207778899Laremont, Ricardo Alexis Pharmacy 340B Coordinator Children's Hospital Colorado 72077788991/14/2020 2:07 PM
Medicaid BillingNPI: NumberInsertChange Request 185194202310/17/2019 1:53 PM
AddressesShipping AddressInsertChange Request Health Pavilion Specialty Pharmacy 860 North Potomac Circle Aurora, CO 800119/16/2019 12:37 PM
DetailsLast Recertification DateUpdateRecertification9/10/2018 11:45:48 AM9/15/2019 8:39:46 AM9/15/2019 8:39 AM
DetailsEntity NameUpdateRecertificationTHE CHILDREN'S HOSPITAL ASSOCIATIONChildren's Hospital Colorado9/15/2019 8:39 AM
ContactsAuthorizing OfficialUpdateAO Change RequestMilton, Jerrod Senior Vice President Professional & Support Services Children's Hospital Colorado 7207772839Dugan, Casey Vice President of Pharmacy Services Children's Hospital Colorado 72077756838/28/2019 1:17 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestMilton, Jerrod VP Operations Children's Hospital Colorado 7207772839Milton, Jerrod Senior Vice President Professional & Support Services Children's Hospital Colorado 72077728398/28/2019 11:16 AM
DetailsLast Recertification DateUpdateRecertification12/5/2017 1:18:20 PM9/10/2018 11:45:48 AM9/10/2018 11:45 AM
AddressesShipping AddressInsertChange Request Children's Hospital Colorado 13123 E 16th Avenue Aurora, CO 800455/21/2018 1:13 PM
AddressesShipping AddressInsertChange Request Children's Hospital Colorado BMT Laboratory 13123 E 16TH AVENUE LOWER LEVEL AURORA, CO 800455/21/2018 1:13 PM
DetailsLast Recertification DateUpdateRecertification9/6/2016 12:00:00 AM12/5/2017 1:18:20 PM12/5/2017 1:18 PM
ContactsAuthorizing OfficialUpdate Milton, Jerrod VP Operations 7207772839Milton, Jerrod VP Operations Children's Hospital Colorado 720777283910/20/2017 11:24 AM
ContactsPrimary ContactUpdateProfile Change RequestLaremont, Ricardo Alexis Pharmacy 340B Coordinator The Childrens Hospital Association 3038177257Laremont, Ricardo Alexis Pharmacy 340B Coordinator The Childrens Hospital Association 72077788999/25/2017 12:04 PM
ContactsPrimary ContactUpdate Laremont, Ricardo Pharmacy 340B Coordinator 3038177257Laremont, Ricardo Alexis Pharmacy 340B Coordinator The Childrens Hospital Association 30381772579/25/2017 11:57 AM
ContactsAuthorizing OfficialInsert  Milton, Jerrod VP Operations 72077728397/26/2017 11:51 AM
AddressesMain AddressUpdate  13123 EAST 16TH AVENUE B375-Pharmacy AURORA, CO 80045 13123 EAST 16TH AVENUE AURORA, CO 800459/27/2016 2:12 PM
AddressesMain AddressInsert   13123 EAST 16TH AVENUE B375-Pharmacy AURORA, CO 800459/27/2016 2:12 PM
ContactsPrimary ContactUpdate Harrington, Jeffrey L. VICE PRESIDENT-FINANCE 7207776364Laremont, Ricardo Pharmacy 340B Coordinator 30381772579/27/2016 2:12 PM
Medicaid BillingNPI: NumberInsert  13362458289/27/2016 2:12 PM
ContactsPrimary ContactUpdate MILTON, JERROD VICE PRESIDENT, OPERATIONS 7207772839Harrington, Jeffrey L. VICE PRESIDENT-FINANCE 72077763649/6/2016 5:44 PM
DetailsLast Recertification DateUpdate 9/8/2015 12:00:00 AM9/6/2016 12:00:00 AM9/6/2016 5:43 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse9/9/2015 1:38 PM
DetailsLast Recertification DateUpdate 8/29/2014 12:00:00 AM9/8/2015 12:00:00 AM9/9/2015 1:38 PM
DetailsLast Recertification DateUpdate 8/30/2013 12:00:00 AM8/29/2014 12:00:00 AM8/29/2014 7:29 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/30/2013 12:00:00 AM8/30/2013 12:59 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM4/25/2012 7:28 AM
ContactsPrimary ContactInsert  MILTON, JERROD VICE PRESIDENT, OPERATIONS 72077728399/9/2010 3:12 PM
DetailsLast Recertification DateInsert   9/9/2010 3:12 PM
DetailsGrant NumberInsert   9/9/2010 3:12 PM
Details340B IDInsert  PED063301-009/9/2010 3:12 PM
DetailsIs Authorizing Official EHB DataInsert   9/9/2010 3:12 PM
DatesLast Date That 340B Drugs PurchasedInsert   9/9/2010 3:12 PM
DetailsMedicare Provider NumberInsert  0633019/9/2010 3:12 PM
DetailsEntity NameInsert  THE CHILDREN'S HOSPITAL ASSOCIATION9/9/2010 3:12 PM
DetailsProgram CodeInsert  PED9/9/2010 3:12 PM
DetailsEntity SubnameInsert   9/9/2010 3:12 PM
DatesParticipating Approval DateInsert  9/9/2010 12:00:00 AM9/9/2010 3:12 PM
DetailsStateInsert  Active9/9/2010 3:12 PM
DatesRegistration DateInsert  8/22/2010 12:00:00 AM9/9/2010 3:12 PM
DatesSigned By DateInsert  8/10/2010 12:00:00 AM9/9/2010 3:12 PM
DatesStart DateInsert  9/9/2010 12:00:00 AM9/9/2010 3:12 PM
TerminationsTermination CommentsInsert   9/9/2010 3:12 PM
TerminationsTermination DateInsert   9/9/2010 3:12 PM
TerminationsTermination Effective DateInsert   9/9/2010 3:12 PM
TerminationsTermination ReasonInsert   9/9/2010 3:12 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True8/22/2010 4:17 PM
Medicaid BillingMedicaid: NumberInsert  050020438/22/2010 4:17 PM
Medicaid BillingMedicaid: StateInsert  CO8/22/2010 4:17 PM