Covered Entity Details

CH08073X Metro Community Provider Network, Inc. (Terminated) - information as of 5/2/2025 10:29:54 PM

Main Details

Name

Metro Community Provider Network, Inc.

Subdivision Name

MCPN - Health & Wellness Center at the Asian Pacific Development Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-012817

340B ID

CH08073X

Grant Number

H80CS00217

Additional Details

Current Program Status

Terminated

Registration Date

1/15/2014

Participating Start Date

4/1/2014

Participating Approval Date

2/25/2014

Last Recertification Date

1/30/2020

Termination Date
Termination Reason

7/1/2020
Site closure

Contacts

Authorizing Official

METRO COMMUNITY PROVIDER NETWORK
Ben Wiederholt, CEO
(303) 761-1977 Ext: 1103

Primary Contact

METRO COMMUNITY PROVIDER NETWORK
Jillian Anderson, 340B Program Manager
(303) 356-0302

Addresses

Street Address

1537 Alton St
Aurora, CO 80010-1712

Billing Address

STRIDE CHC- Administration
2255 S. Oneida St
Denver, CO 80224-2522

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
CO	32305036
		1649605536,1457997660,1447896659

Shipping Addresses

Shipping Address 1

STRIDE CHC Pharmacy
3292 Peoria St.
Aurora, CO 80010

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
CH080730	Active	BPS-H80-007555	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Peoria	3292 Peoria St	Aurora	CO
CH08073AA	Terminated	BPS-H80-017724	METRO COMMUNITY PROVIDER NETWORK, INC.	MCPN Fitzsimmons Crisis Services Center	2206 Victor Street	Aurora	CO
CH08073AB	Active	BPS-H80-017310	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Del Mar	10680 Del Mar Pkwy	Aurora	CO
CH08073AC	Terminated	BPS-H80-017725	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Jefferson Plaza Family Health at Jefferson Center	3595 S Teller St	Lakewood	CO
CH08073AD	Approved	BPS-H80-029461	METRO COMMUNITY PROVIDER NETWORK INC	STRIDE CHC – Oneida	2255 S. Oneida St.	Denver	CO
CH08073AE	Active	BPS-H80-027766	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Golden High School	701 24th Street	Golden	CO
CH08073AF	Terminated	BPS-H80-030123	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- East Colfax	9801 E Colfax Ave Ste 130	Aurora	CO
CH08073AG	Terminated	BPS-H80-030091	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Potomac Street	750 Potomac St Ste L23	Aurora	CO
CH08073AH	Active	BPS-H80-030201	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Mobile Health Care Unit	11005 Ralston Rd	Arvada	CO
CH08073AJ	Active	BPS-H80-032313	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC - Conifer	11030 Kitty Drive RM Exam RM 1	Conifer	CO
CH08073AK	Active	BPS-H80-034103	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC - Overland High School	12400 E Jewell Ave Unit A	Aurora	CO
CH08073AL	Active	BPS-H80-034102	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC - Horizon Community Middle School	3981 S Reservoir Rd Unit A	Aurora	CO
CH08073AM	Active	BPS-H80-034492	Metro Community Provider Network, Inc.	STRIDE CHC - Mobile Health Unit #3	3515 S Delaware St	Englewood	CO
CH08073AN	Active	BPS-H80-034449	Metro Community Provider Network, Inc.	STRIDE CHC - Mobile Health Unit #2	7495 W 29th Ave	Wheat Ridge	CO
CH08073AP	Active	BPS-H80-037388	METRO COMMUNITY PROVIDER NETWORK INC	Smoky Hill High School Community Health Clinic	16100 E Smoky Hill Rd	Aurora	CO
CH08073AQ	Active	BPS-H80-037377	METRO COMMUNITY PROVIDER NETWORK INC	STRIDE CHC -Alameda	7944 West Arizona Ave	Lakewood	CO
CH08073B	Terminated	BPS-H80-003425	Metro Community Provider Network, Inc.	MCPN Lakewood Health Center	8500 W. COLFAX AVE	LAKEWOOD	CO
CH08073D	Terminated	BPS-H80-002616	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- West Arvada	11005 Ralston Rd STE 100G	Arvada	CO
CH08073F	Terminated	BPS-H80-014112	Metro Community Provider Network, Inc.	Chambers Clinic at AuMHC	791 Chambers	Aurora	CO
CH08073G	Terminated	BPS-H80-010942	METRO COMMUNITY PROVIDER NETWORK, INC.	Colfax Clinic at JCMH	9485 W Colfax Ave	Lakewood	CO
CH08073H	Active	BPS-H80-003249	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Englewood	3515 S Delaware St	Englewood	CO
CH08073J	Terminated	BPS-H80-005463	METRO COMMUNITY PROVIDER NETWORK, INC.	ESTES STREET COMMUNITY CLINIC	8755 W. 14TH STREET	LAKEWOOD	CO
CH08073K	Terminated	BPS-H80-010941	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Independence at Jefferson Center	4851 Independence St	Wheat Ridge	CO
CH08073L	Terminated	BPS-H80-002615	METRO COMMUNITY PROVIDER NETWORK, INC.	JEFFERSON HIGH SCHOOL CLINIC	2305 PIERCE ST	EDGEWATER	CO
CH08073M	Active	BPS-H80-005081	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Hampden and Chambers	15132 E Hampden Ave STE G	Aurora	CO
CH08073N	Terminated	BPS-H80-004738	Metro Community Provider Network, Inc.	POTOMAC STREET HEALTH CLINIC	700 Potomac St STE A	Aurora	CO
CH08073P	Active	BPS-H80-000759	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Rose Stein Elementary School	80 S. TELLER ST	LAKEWOOD	CO
CH08073R	Terminated	BPS-H80-009399	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Alameda High School	1255 S. Wadsworth Blvd	Lakewood	CO
CH08073S	Terminated	BPS-H80-003291	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Helena	15501 E 13th Ave	Aurora	CO
CH08073T	Terminated	BPS-H80-022099	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Union Square Health Plaza at Jefferson Center	12055 W 2nd Pl	Lakewood	CO
CH08073U	Terminated	BPS-H80-005402	Metro Community Provider Network, Inc.	METRO COMMUNITY PROVIDER NETWORK	3701 S Broadway	Englewood	CO
CH08073V	Terminated	BPS-H80-012518	Metro Community Provider Network, Inc.	Elmira Refugee Health Center	1666 ELMIRA ST	AURORA	CO
CH08073W	Active	BPS-H80-012015	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Wheat Ridge	7495 W 29th Ave	Wheat Ridge	CO
CH08073X	Terminated	BPS-H80-012817	Metro Community Provider Network, Inc.	MCPN - Health & Wellness Center at the Asian Pacific Development Center	1537 Alton St	Aurora	CO
CH08073Y	Terminated	BPS-H80-013626	METRO COMMUNITY PROVIDER NETWORK, INC.	MCPN Arapahoe Douglas Health Center	61 W DAVIES AVE N	LITTLETON	CO
CH08073Z	Terminated	BPS-H80-022098	METRO COMMUNITY PROVIDER NETWORK, INC.	STRIDE CHC- Parker	17866 Cottonwood Dr	Parker	CO

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH080730	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2023
CH080730	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2023
CH080730	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2023
CH080730	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2023
CH080730	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/01/2023
CH080730	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2023
CH080730	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	07/01/2018
CH080730	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	04/01/2025
CH080730	AMAZON PHARMACY #008	408 TECHNOLOGY PARKWAY	BUILDING B, STE 101	COLLEGE STATION	TX	77845	04/01/2025
CH080730	AMAZON PHARMACY #009	7469 KINGSPOINTE PKWY STE 400		ORLANDO	FL	32819	04/01/2025
CH080730	AMAZON PHARMACY #010	1331 E 6TH ST		CORONA	CA	92879	04/01/2025
CH080730	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH08073AN	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2025
CH080730	BLUE SPRUCE PHARMACY	9485 W COLFAX AVE		LAKEWOOD	CO	80215-3918	04/01/2019
CH080730	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2024
CH080730	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 17092	7400 S GARTRELL RD	AURORA	CO	80016	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 17511	15700 E BRIARWOOD CIR	AURORA	CO	80016	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 17335	3650 RIVERPOINT PKWY	SHERIDAN	CO	80110	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 17142	7930 NORTHFIELD BLVD	DENVER	CO	80238	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 17604	460 S VANCE ST	LAKEWOOD	CO	80226	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 17114	5071 KIPLING ST	WHEAT RIDGE	CO	80033	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 16831	14500 W COLFAX AVE UNIT B1	LAKEWOOD	CO	80401	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 16803	14200 E ELLSWORTH AVE	AURORA	CO	80012	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 16751	1400 S HAVANA ST	AURORA	CO	80012	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 16074	16910 E QUINCY AVE	AURORA	CO	80015	04/01/2024
CH080730	CVS PHARMACY, INC.	DBA CVS/PHARMACY #10785	16920 LINCOLN AVENUE	PARKER	CO	80134	04/01/2024
CH080730	CVS PHARMACY, INC.	CVS PHARMACY # 16009	7899 WADSWORTH BLVD	ARVADA	CO	80003	04/01/2024
CH080730	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	07/01/2018	05/17/2019
CH080730	DIVVYMED, LLC	DIVVYMED LLC DBA DIVVYDOSE	4300 44TH AVE	MOLINE	IL	61265	04/01/2024
CH080730	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2023
CH080730	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2023
CH080730	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2023
CH080730	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2023
CH080730	IC PHARMACY LLC	AMAZON PHARMACY #004	34 35TH STREET STE 4BSW, UNIT 28	BROOKLYN	NY	11232	04/01/2025
CH080730	KING SOOPERS #124	4600 LEETSDALE		GLENDALE	CO	80246	07/01/2019	02/23/2020
CH080730	KING SOOPERS #30	ATTN: PHARMACY	1155 S. HAVANA	AURORA	CO	80012	04/01/2019
CH08073AH	KING SOOPERS #30	ATTN: PHARMACY	1155 S. HAVANA	AURORA	CO	80012	04/01/2025
CH080730	KING SOOPERS PHARMACY	DIV DILLON COMPANIES INC	9731 W 58TH AVE	ARVADA	CO	80002	04/01/2019
CH080730	KING SOOPERS PHARMACY	DIV DILLON CO	1155 E 9TH AVE	DENVER	CO	80218	07/01/2019	02/23/2020
CH08073AG	KING SOOPERS PHARMACY	DIV DILLON COMPANIES INC	9731 W 58TH AVE	ARVADA	CO	80002	04/01/2025	04/01/2025
CH080730	KING SOOPERS PHARMACY #1	1331 NORTH SPEER BLVD		DENVER	CO	80204	07/01/2019	02/23/2020
CH080730	KING SOOPERS PHARMACY #10	15250 EAST MISSISSIPPI		AURORA	CO	80012	01/01/2022
CH08073AM	KING SOOPERS PHARMACY #10	15250 EAST MISSISSIPPI		AURORA	CO	80012	04/01/2025
CH080730	KING SOOPERS PHARMACY #109	5050 SOUTH FEDERAL		ENGLEWOOD	CO	80110	07/01/2019	02/23/2020
CH080730	KING SOOPERS PHARMACY #14	655 PEORIA ST		AURORA	CO	80011	04/01/2019
CH08073AB	KING SOOPERS PHARMACY #14	655 PEORIA ST		AURORA	CO	80011	04/01/2025
CH080730	KING SOOPERS PHARMACY #3	6350 SHERIDAN BLVD.		ARVADA	CO	80003	04/01/2019
CH080730	KING SOOPERS PHARMACY #49	17000 E ILIFF		AURORA	CO	80013	07/01/2019
CH08073AJ	KING SOOPERS PHARMACY #49	17000 E ILIFF		AURORA	CO	80013	04/01/2025
CH080730	KING SOOPERS PHARMACY #52	15109 E COLFAX		AURORA	CO	80011	01/01/2022
CH08073AE	KING SOOPERS PHARMACY #52	15109 E COLFAX		AURORA	CO	80011	04/01/2025
CH080730	KING SOOPERS PHARMACY #60	1555 QUAIL		LAKEWOOD	CO	80215	04/01/2019
CH08073AK	KING SOOPERS PHARMACY #60	1555 QUAIL		LAKEWOOD	CO	80215	04/01/2025
CH080730	KING SOOPERS PHARMACY #65	101 ENGLEWOOD PARKWAY		ENGLEWOOD	CO	80110	07/01/2019	06/07/2020
CH080730	KING SOOPERS PHARMACY #90	1725 SHERIDAN BLVD.		EDGEWATER	CO	80214	01/01/2022
CH08073AL	KING SOOPERS PHARMACY #90	1725 SHERIDAN BLVD.		EDGEWATER	CO	80214	04/01/2025
CH080730	KING SOOPERS PHARMACY #93	2810 QUEBEC ST		DENVER	CO	80207	07/01/2019	02/23/2020
CH080730	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	10/01/2018
CH080730	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	04/01/2024
CH080730	OPTUM INFUSION SERVICES 308, LLC	6547 S RACINE CIR STE 300		CENTENNIAL	CO	80111	04/01/2024
CH080730	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	04/01/2024
CH080730	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	04/01/2024
CH080730	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	04/01/2024
CH080730	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/01/2024
CH080730	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/01/2024
CH080730	OVERLAKE PHARMACY, LLC	4124 148TH AVE NE STE JA		REDMOND	WA	98052	04/01/2020	01/16/2024
CH080730	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	07/01/2018
CH080730	PILLPACK LLC	AMAZON PHARMACY #005	20416 72ND AVE S	KENT	WA	98032-2319	04/01/2025
CH080730	SCALES PHARMACY LLC	SCALES PHARMACY	1999 N PENNSYLVANIA ST	DENVER	CO	80203-1314	01/01/2020	01/08/2020
CH080730	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	04/01/2019
CH080730	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	04/01/2020	01/16/2024
CH080730	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2019	03/29/2024
CH080730	WAL-MART PHARMACY 10-1308	7700 WEST QUINCY AVE		LITTLETON	CO	80123	01/01/2022	03/09/2023
CH080730	WAL-MART PHARMACY 10-1492	14000 EAST EXPOSITION AVENUE		AURORA	CO	80012	04/01/2019
CH080730	WAL-MART PHARMACY 10-1689	5650 SOUTH CHAMBERS RD		AURORA	CO	80015	04/01/2019
CH080730	WAL-MART PHARMACY 10-2125	7455 WEST COLFAX AVE		LAKEWOOD	CO	80214	04/01/2019
CH080730	WAL-MART PHARMACY 10-2751	601 ENGLEWOOD PKWY		ENGLEWOOD (N)	CO	80110	07/01/2019
CH080730	WAL-MART PHARMACY 10-3824	7155 SHERIDAN BLVD		WESTMINISTER	CO	80003	04/01/2019
CH080730	WAL-MART PHARMACY 10-4284	440 WADSWORTH BLVD		LAKEWOOD	CO	80226	01/01/2022
CH080730	WAL-MART PHARMACY 10-5334	3301 NORTH TOWER ROAD		AURORA	CO	80011	04/01/2019	02/20/2020
CH080730	WAL-MART PHARMACY 10-5334	3301 NORTH TOWER ROAD		AURORA	CO	80011	01/01/2022
CH080730	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2019
CH080730	WALGREEN CO	DBA WALGREENS SPECIALTY PHARMACY #11255	4545 E 9TH AVE STE 100	DENVER	CO	80220	04/01/2019
CH080730	WALGREEN CO	DBA: WALGREENS #10739	15310 E COLFAX AVE	AURORA	CO	80011	04/01/2019
CH080730	WALGREEN CO	DBA: WALGREENS #11615	24250 E. SMOKY HILL RD	AURORA	CO	80016	04/01/2022
CH080730	WALGREEN CO	DBA: WALGREENS #10306	3510 EVERGREEEN PKWY	EVERGREEN	CO	80439	04/01/2022
CH08073AN	WALGREEN CO	DBA: WALGREENS #10739	15310 E COLFAX AVE	AURORA	CO	80011	04/01/2025
CH080730	WALGREEN CO.	DBA: WALGREENS # 03655	10501 E. COLFAX AVE.	AURORA	CO	80010	04/01/2019	11/13/2024
CH080730	WALGREEN CO.	DBA: WALGREENS # 12100	7930 WADSWORTH BLVD.	ARVADA	CO	80003	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS #13968	7551 W. ALAMEDA AVE	LAKEWOOD	CO	80226	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS #10175	12011 E ILIFF AVE	AURORA	CO	80014	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 01306	11605 W BELLEVIEW AVE	LITTLETON	CO	80127	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 06513	15301 E ILIFF AVE	AURORA	CO	80013	04/01/2019	02/24/2025
CH080730	WALGREEN CO.	DBA: WALGREENS #10116	3067 S SHERIDAN BLVD	DENVER	CO	80227-4150	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 12423	123 E BELLEVIEW AVE	ENGLEWOOD	CO	80113-5802	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 07253	18550 GREEN VALLEY RANCH BLVD	DENVER	CO	80249-6662	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 06883	12700 W 32ND AVE	WHEAT RIDGE	CO	80033-5251	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 03499	11602 W 64TH AVE	ARVADA	CO	80004	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 03266	6395 SHERIDAN BLVD.	ARVADA	CO	80003	04/01/2019	02/20/2025
CH080730	WALGREEN CO.	DBA: WALGREENS # 10117	17222 S GOLDEN RD	GOLDEN	CO	80401	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 04307	12051 E MISSISSIPPI AVE	AURORA	CO	80012	04/01/2019	02/19/2025
CH080730	WALGREEN CO.	DBA: WALGREENS # 06284	6789 W COAL MINE AVE	LITTLETON	CO	80123	04/01/2019	07/08/2020
CH080730	WALGREEN CO.	DBA: WALGREENS # 06621	10808 W JEWELL AVE	LAKEWOOD	CO	80232	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 09566	12880 W ALAMEDA PKWY	LAKEWOOD	CO	80228-3115	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 04469	15301 E. MISSISSIPPI AVE.	AURORA	CO	80017	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 03589	5870 S. KIPLING PARKWAY	LITTLETON	CO	80127	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 07021	18620 E ILIFF AVE	AURORA	CO	80013-5995	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 04366	4401 WADSWORTH BLVD.	WHEAT RIDGE	CO	80033	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 04610	18461 E HAMPDEN AVE	AURORA	CO	80013	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS #12024	15320 E. HAMPDEN AVE	AURORA	CO	80013	04/01/2019	02/22/2024
CH080730	WALGREEN CO.	DBA: WALGREENS # 09657	5151 W COLFAX AVE	DENVER	CO	80204-1016	04/01/2019	11/12/2024
CH080730	WALGREEN CO.	DBA: WALGREENS # 09887	10140 W. COLFAX AVENUE	LAKEWOOD	CO	80215-3910	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 09034	6603 WADSWORTH BLVD	ARVADA	CO	80003-3945	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 07432	2697 W BELLEVIEW AVE	LITTLETON	CO	80123	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 06986	10601 E ALAMEDA AVE	AURORA	CO	80012	04/01/2019
CH080730	WALGREEN CO.	DBA: WALGREENS # 04667	1601 W. 84TH AVE.	FEDERAL HEIGHTS	CO	80260-5001	04/01/2019	02/06/2025
CH080730	WALGREEN CO.	DBA: WALGREENS # 04470	20051 E SMOKY HILL RD	CENTENNIAL	CO	80015	04/01/2022
CH080730	WALGREEN CO.	DBA: WALGREENS # 06344	1821 E BRIDGE ST STE A	BRIGHTON	CO	80601-1935	04/01/2022
CH080730	WALGREEN CO.	DBA: WALGREENS # 06826	6390 MCINTYRE PKWY	ARVADA	CO	80403	04/01/2022
CH080730	WALGREEN CO.	DBA: WALGREENS # 03298	3080 S BROADWAY	ENGLEWOOD	CO	80113	04/01/2022	09/30/2024
CH080730	WALGREEN CO.	DBA: WALGREENS # 04894	8799 WASHINGTON ST	THORNTON	CO	80229-4713	04/01/2022
CH080730	WALGREEN CO.	DBA: WALGREENS # 10704	8959 E DRY CREEK RD	CENTENNIAL	CO	80112-2765	04/01/2022
CH080730	WALGREEN CO.	DBA: WALGREENS # 03867	6200 E COLFAX	DENVER	CO	80220	04/01/2022
CH080730	WALGREEN CO.	DBA: WALGREENS # 11101	7190 E HAMPDEN AVE	DENVER	CO	80224	04/01/2022
CH080730	WALGREEN CO.	DBA: WALGREENS #13148	16950 E. SMOKY HILL RD	CENTENNIAL	CO	80015	04/01/2022
CH080730	WALGREEN CO.	DBA: WALGREENS # 10070	6360 E EVANS AVE	DENVER	CO	80222	04/01/2022	02/27/2025
CH080730	WALGREEN CO.	DBA: WALGREENS # 03500	950 S QUEBEC ST	DENVER	CO	80247	04/01/2022
CH080730	WALGREEN CO.	DBA: WALGREENS # 06827	1505 S FEDERAL BLVD	DENVER	CO	80219-4722	04/01/2022	02/29/2024
CH080730	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16516	2608 E COLFAX AVE	DENVER	CO	80206	01/01/2023
CH08073P	WALGREEN CO.	DBA: WALGREENS # 04610	18461 E HAMPDEN AVE	AURORA	CO	80013	04/01/2025
CH08073AQ	WALGREEN CO.	DBA: WALGREENS # 03655	10501 E. COLFAX AVE.	AURORA	CO	80010	04/01/2025
CH08073M	WALGREEN CO.	DBA: WALGREENS # 09034	6603 WADSWORTH BLVD	ARVADA	CO	80003-3945	04/01/2025
CH08073AP	WALGREEN CO.	DBA: WALGREENS # 04469	15301 E. MISSISSIPPI AVE.	AURORA	CO	80017	04/01/2025
CH08073H	WALGREEN CO.	DBA: WALGREENS # 04307	12051 E MISSISSIPPI AVE	AURORA	CO	80012	04/01/2025
CH080730	Walgreens #21397	Walgreens Central Fill #21397	5675 Pecos St. Suite 100	Denver	CO	80221-6655	10/01/2022
CH080730	WALMART PHARMACY #10-4734	9400 RALSTON ROAD		ARVADA	CO	80002	01/01/2022
CH080730	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023	03/29/2024
CH080730	WALMART PHARMACY 10-6178	10400 E COLFAX AVENUE		AURORA	CO	80010	04/01/2019	05/30/2024
CH080730	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024	03/30/2024
CH080730	WESTERN PHARMACY GROUP LLC	DBA COMMUNITY MEDICAL CENTER PHARMACY	610 GATEWAY CENTER WAY SUITES A--E	SAN DIEGO	CA	92102	10/01/2018	05/16/2022

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Recertification	Anderson, Jillian Manager, 340B Program METRO COMMUNITY PROVIDER NETWORK 3033606276-2163	Anderson, Jillian 340B Program Manager METRO COMMUNITY PROVIDER NETWORK 3033560302	2/17/2022 4:48 PM
Details	State	Update		To Be Terminated	Terminated	7/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		2/14/2020 12:00:00 AM	6/29/2020 11:07 AM
Details	State	Update	Termination Request	Active	To Be Terminated	6/29/2020 11:07 AM
Terminations	Termination Comments	Update	Termination Request		Site slated to close in June; however, the location has been closed since March due to the COVID-19 pandemic.	6/29/2020 11:07 AM
Terminations	Termination Date	Update	Termination Request		7/1/2020 12:00:00 AM	6/29/2020 11:07 AM
Terminations	Termination Effective Date	Update	Termination Request		6/30/2020 12:00:00 AM	6/29/2020 11:07 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	6/29/2020 11:07 AM
Addresses	Shipping Address	Insert	Change Request		STRIDE CHC Pharmacy 3292 Peoria St. Aurora, CO 80010	6/5/2020 10:51 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 4:29:47 AM	1/30/2020 6:57:20 PM	1/30/2020 6:57 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1457997660	1/27/2020 10:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1447896659	1/27/2020 10:34 AM
Addresses	Billing Address	Update	Change Request	Metro Community Provider Network, Inc. 3701 S Broadway Englewood, CO 80113-3611	STRIDE CHC- Administration 2255 S. Oneida St Denver, CO 80224-2522	11/5/2019 10:30 AM
Contacts	Primary Contact	Update	Change Request	Anderson, Jillian 340B Program Manager Metro Community Provider Network 3033606276-2163	Anderson, Jillian Manager, 340B Program METRO COMMUNITY PROVIDER NETWORK 3033606276-2163	11/5/2019 10:30 AM
Contacts	Authorizing Official	Update	Change Request	Wiederholt, Ben CEO Metro Community Provider Network 3037611977-1103	Wiederholt, Ben CEO METRO COMMUNITY PROVIDER NETWORK 3037611977-1103	11/5/2019 10:30 AM
Addresses	Billing Address	Update	Change Request	Metro Community Provider Network 3701 S BROADWAY ENGLEWOOD, CO 80113	Metro Community Provider Network, Inc. 3701 S Broadway Englewood, CO 80113-3611	2/19/2019 7:57 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	10552511	32305036	2/19/2019 7:57 AM
Details	Entity Name	Update	Change Request	METRO COMMUNITY PROVIDER NETWORK, INC.	Metro Community Provider Network, Inc.	2/19/2019 7:57 AM
Addresses	Billing Address	Update	Change Request	MCPN - ADMINISTRATION 3701 S BROADWAY ENGLEWOOD, CO 80113	Metro Community Provider Network 3701 S BROADWAY ENGLEWOOD, CO 80113	2/11/2019 11:15 AM
Addresses	Shipping Address	Delete	Change Request	MCPN Pharmacy 3292 PEORIA ST AURORA, CO 80010		2/11/2019 11:15 AM
Contacts	Primary Contact	Update	Change Request	Alexander, Paula Director of Pharmacy Metro Community Provider Network 3033606276-2106	Anderson, Jillian 340B Program Manager Metro Community Provider Network 3033606276-2163	2/11/2019 11:15 AM
Details	Last Recertification Date	Update	Recertification	3/1/2018 3:03:55 PM	1/29/2019 4:29:47 AM	1/29/2019 4:29 AM
Contacts	Primary Contact	Update	Change Request	Alexander, Paula Pharmacy Director MCPN 3033606276	Alexander, Paula Director of Pharmacy Metro Community Provider Network 3033606276-2106	3/6/2018 12:28 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		3/6/2018 12:28 PM
Details	Last Recertification Date	Update	Recertification	2/9/2017 12:00:00 AM	3/1/2018 3:03:55 PM	3/1/2018 3:03 PM
Contacts	Primary Contact	Update	Recertification	Alexander, Paula Pharmacy Director 3033606276	Alexander, Paula Pharmacy Director MCPN 3033606276	3/1/2018 2:56 PM
Contacts	Authorizing Official	Update	AO Change Request	Myers, David S. CEO 3037611977-1104	Wiederholt, Ben CEO Metro Community Provider Network 3037611977-1103	2/23/2018 2:46 PM
Contacts	Primary Contact	Update		Wedemeyer, Henry Pharmacy Director 3038089058	Alexander, Paula Pharmacy Director 3033606276	4/13/2017 2:10 PM
Contacts	Authorizing Official	Insert			Myers, David S. CEO 3037611977-1104	4/13/2017 2:10 PM
Contacts	Signed By	Insert			Myers, David S. CEO 3037611977-1104	4/13/2017 2:10 PM
Addresses	Main Address	Insert			1537 Alton St Aurora, CO 80010-1712	2/13/2017 2:26 PM
Details	Last Recertification Date	Update		2/12/2016 12:00:00 AM	2/9/2017 12:00:00 AM	2/13/2017 2:26 PM
Addresses	Shipping Address	Insert			MCPN Pharmacy 3292 PEORIA ST AURORA, CO 80010	2/12/2016 2:08 PM
Details	Last Recertification Date	Update		2/11/2015 12:00:00 AM	2/12/2016 12:00:00 AM	2/12/2016 2:08 PM
Contacts	Primary Contact	Insert			Wedemeyer, Henry Pharmacy Director 3038089058	2/11/2015 11:56 AM
Medicaid Billing	NPI: Number	Update		1255591780	1649605536	2/11/2015 11:56 AM
Details	Last Recertification Date	Update			2/11/2015 12:00:00 AM	2/11/2015 11:56 AM
Details	Is Authorizing Official EHB Data	Update			False	2/11/2015 11:56 AM
Addresses	Billing Address	Insert			MCPN - ADMINISTRATION 3701 S BROADWAY ENGLEWOOD, CO 80113	2/25/2014 3:14 PM
Details	340B ID	Update		ONLINE_REG	CH08073X	2/25/2014 3:14 PM
Dates	Participating Approval Date	Update			2/25/2014 12:00:00 AM	2/25/2014 3:14 PM
Details	State	Update		Pending	Active	2/25/2014 3:14 PM
Dates	Start Date	Update			4/1/2014 12:00:00 AM	2/25/2014 3:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/15/2014 4:34 PM
Medicaid Billing	Medicaid: Number	Insert			10552511	1/15/2014 4:34 PM
Medicaid Billing	Medicaid: State	Insert			CO	1/15/2014 4:34 PM
Medicaid Billing	NPI: Number	Insert			1255591780	1/15/2014 4:34 PM
Details	Last Recertification Date	Insert				1/15/2014 4:34 PM
Details	Grant Number	Insert			H80CS00217	1/15/2014 4:34 PM
Details	340B ID	Insert			ONLINE_REG	1/15/2014 4:34 PM
Details	Is Authorizing Official EHB Data	Insert				1/15/2014 4:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/15/2014 4:34 PM
Details	Medicare Provider Number	Insert				1/15/2014 4:34 PM
Details	Entity Name	Insert			METRO COMMUNITY PROVIDER NETWORK, INC.	1/15/2014 4:34 PM
Details	Program Code	Insert			CH	1/15/2014 4:34 PM
Details	Entity Subname	Insert			MCPN - Health & Wellness Center at the Asian Pacific Development Center	1/15/2014 4:34 PM
Dates	Participating Approval Date	Insert				1/15/2014 4:34 PM
Details	State	Insert			Pending	1/15/2014 4:34 PM
Dates	Registration Date	Insert			1/15/2014 12:00:00 AM	1/15/2014 4:34 PM
Dates	Signed By Date	Insert			1/15/2014 12:00:00 AM	1/15/2014 4:34 PM
Dates	Start Date	Insert				1/15/2014 4:34 PM
Terminations	Termination Comments	Insert				1/15/2014 4:34 PM
Terminations	Termination Date	Insert				1/15/2014 4:34 PM
Terminations	Termination Effective Date	Insert				1/15/2014 4:34 PM
Terminations	Termination Reason	Insert				1/15/2014 4:34 PM

340B Drug Pricing Program Database