Covered Entity Details

CH09003L SUN LIFE FAMILY HEALTH CENTER, INC. (Active) - information as of 6/9/2025 11:05:13 PM

Main Details

Name

SUN LIFE FAMILY HEALTH CENTER, INC.

Subdivision Name

Sun Life Health - Mesa Family Practice

Type

HRSA-Funded Health Center

Site ID

BPS-H80-035987

340B ID

CH09003L

Grant Number

H80CS00466

Additional Details

Current Program Status

Active

Registration Date

7/9/2014

Participating Start Date

10/1/2014

Participating Approval Date

7/23/2014

Last Recertification Date

3/4/2025

Contacts

Authorizing Official

Sun Life Family Health Center
Eddie Estrada, Chief Executive Officer
(520) 836-3446

Primary Contact

Sun Life Family Health Center, INC
Matthew Bertsch, Director of Pharmacy
(520) 381-0363

Addresses

Street Address

10032 E Southern Avenue
Mesa, AZ 85209

Billing Address

Sun Life Family Health Center, INC
PO Box 10097
Casa Grande, AZ 85130

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
AZ	039885,572325,494576,341643,088592,304914,085022,105273,912044,474518,183991,912404,912431,912549,912107,912512,11694,912440,102639,011694,315835,104663,106103,920306,011702	1699176354,1508276940,1689778623,1275693947,1609186386,1851457295,1063887149,1043740566,1528678000,1871250910,1891913166,1063999837,1881073443,1588876429,1033321989,1467666206,1417286568,1902018856,1548690332,1548472475,1902278252,1992166359,1396275459,1639831985

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
CH090030	Active	BPS-H80-002312	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Casa Grande Family Practice, Dental & Orthodontics	865 N Arizola Rd	Casa Grande	AZ
CH09003A	Active	BPS-H80-000636	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Maricopa Center for Women	44765 W. HATHAWAY AVE	MARICOPA	AZ
CH09003B	Active	BPS-H80-008904	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Eloy Family Practice	205 N. Stuart Blvd.	Eloy	AZ
CH09003D	Active	BPS-H80-004992	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Coolidge Family Practice	1284 N. ARIZONA BLVD	COOLIDGE	AZ
CH09003E	Active	BPS-H80-000940	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - San Manuel Family Practice	23 S Mcnab Pkwy	San Manuel	AZ
CH09003F	Active	BPS-H80-009168	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Casa Grande Center for Children	1856 E. Florence Blvd	Casa Grande	AZ
CH09003G	Active	BPS-H80-024787	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Oracle Family Practice	1040 W American Ave	Oracle	AZ
CH09003K	Active	BPS-H80-033121	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Casa Grande Center for Women	580 N Camino Mercado Ste 8	Casa Grande	AZ
CH09003L	Active	BPS-H80-035987	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Mesa Family Practice	10032 E Southern Avenue	Mesa	AZ
CH09003M	Active	BPS-H80-011268	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Mobile Health Unit	865 N Arizola Rd	Casa Grande	AZ
CH09003N	Active	BPS-H80-015294	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Maricopa Family Practice & Center for Women	44572 W. Bowlin Road	Maricopa	AZ
CH09003P	Terminated	BPS-H80-017383	SUN LIFE FAMILY HEALTH CENTER, INC.	Florence Satellite - Family Practice Office	150 South Main Street	Florence	AZ
CH09003Q	Active	BPS-H80-017642	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Family Health Center Dental Office	1864 E Florence Blvd., Suite #1	Casa Grande	AZ
CH09003R	Active	BPS-H80-020976	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Florence Family Practice	174 W Highway 287	Florence	AZ
CH09003S	Active	BPS-H80-019587	SUN LIFE FAMILY HEALTH CENTER, INC.	Sun Life Health - Chandler Center for Women	655 S Dobson Road, Suite #201	Chandler	AZ
CH09003T	Active	BPS-H80-013665	Sun Life Family Health Center, Inc	Sun Life Health - Casa Grande Walk-in Care	1864 E Florence Blvd Ste 2	Casa Grande	AZ

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH090030	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2020
CH090030	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2020
CH090030	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2020
CH090030	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2020
CH090030	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2020
CH090030	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2020
CH090030	ARIZONA CVS STORES, L.L.C.	DBA: CVS/PHARMACY # 09293	325 W APACHE TRAIL	APACHE JUNCTION	AZ	85120	07/01/2019
CH090030	BASHAS UNITED DRUG # 109	21044 N JOHN WAYNE PKWY		MARICOPA	AZ	85139	04/01/2019
CH090030	BASHAS' UNITED DRUG #52	15310 N ORACLE RD		TUCSON	AZ	85739-9426	04/01/2019
CH090030	CASA GRANDE PHARMACY	1659 E FLORENCE BLVD, STE 7		CASA GRANDE	AZ	85122-4785	07/01/2019	06/01/2021
CH090030	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD N STE 1400		ST PETERSBURG	FL	33716	04/01/2022
CH090030	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	04/01/2022
CH090030	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2019
CH090030	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2020
CH090030	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2020
CH090030	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2020
CH090030	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2020
CH090030	GENOA HEALTHCARE LLC	1101 NORTH CENTRAL AVE	STE 102	PHOENIX	AZ	85004	01/19/2023
CH090030	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 00086	1686 E FLORENCE BLVD	CASA GRANDE	AZ	85122	01/01/2015
CH090030	GERMAN DOBSON CVS, L.L.C.	DBA CVS/PHARMACY # 10006	10650 NORTH ORACLE RD	ORO VALLEY	AZ	85737	07/01/2019
CH090030	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 06719	44274 WEST-SMITH ENKE RD.	MARICOPA	AZ	85138-2719	07/01/2019
CH090030	GERMAN DOBSON CVS, L.L.C.	DBA: CVS/PHARMACY # 05315	2005 N. DOBSON RD.	CHANDLER	AZ	85224	07/01/2020
CH090030	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	04/01/2020
CH090030	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/01/2020
CH090030	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	04/01/2020
CH090030	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/01/2020
CH090030	OPTUM PHARMACY 805, INC	1101 N CENTRAL AVE, STE 102		PHOENIX	AZ	85004-1829	04/01/2020	04/26/2023
CH090030	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/01/2019	10/01/2022
CH090030	SAFEWAY INC	SAFEWAY PHARMACY #1706	1637 N TREKELL RD	CASA GRANDE	AZ	85122	05/24/2011
CH090030	SAFEWAY INC	SAFEWAY PHARMACY #0253	3185 W. APACHE TRAIL	APACHE JUNCTION	AZ	85120	10/01/2014
CH090030	SAFEWAY INC	SAFEWAY PHARMACY #2835	3325 NORTH HUNT HIGHWAY	FLORENCE	AZ	85132	04/01/2017
CH09003D	SAFEWAY INC	SAFEWAY PHARMACY #1732	1449 N. ARIZONA BLVD	COOLIDGE	AZ	85128-3214	05/18/2011
CH090030	SENDERRA RX PHARMACY	SENDERRA RX PARTNERS, LLC	3712 E PLANO PKWY STE 200	PLANO	TX	75074	04/01/2022
CH09003D	SMITH'S FOOD & DRUG CTRS	DBA FRY'S FOOD STORES #84	542 E. HUNT HWY	SAN TAN VALLEY	AZ	85143	09/30/2010
CH09003A	SMITH'S FOOD DRUG CENTERS, INC	FRYS PHARMACY #672	20797 N JOHN WAYNE PKWY	MARICOPA	AZ	85139	09/30/2010
CH090030	SMITHS FOOD & DRUG CENTERS	DBA FRYS FOOD & DRUG #48	1385 E FLORENCE BLVD.	CASA GRANDE	AZ	85122	09/30/2010
CH090030	SMITHS FOOD & DRUG CENTERS	D/B/A FRY'S PHARMACY #665	150 E OLD WEST HIGHWAY	APACHE JUNCTION	AZ	85119	04/01/2017
CH09003E	SMITHS FOOD & DRUG CENTERS	DBA FRYS FOOD & DRUG #18	10661 N ORACLE ROAD	ORO VALLEY	AZ	85737	09/30/2010
CH090030	SMITHS FOOD AND DRUG CENTERS INC	DBA FRYS FOOD STORES OF AZ #682	155 W COMBS RD	SAN TAN VALLEY	AZ	85140	04/01/2017	08/11/2018
CH090030	SMITHS FOOD AND DRUG CENTERS INC	DBA FRYS FOOD STORES OF AZ #669	2858 N PINAL AVE	CASA GRANDE	AZ	85122	04/01/2017
CH090030	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2017
CH090030	WAL-MART PHARMACY # 10-3379	2150 EAST TANGERINE RD		ORO VALLEY	AZ	85755	07/01/2013
CH090030	WAL-MART PHARMACY 10-1218	1741 EAST FLORENCE BLVD		CASA GRANDE	AZ	85122	03/05/2012
CH090030	WAL-MART PHARMACY 10-1325	455 EAST WETMORE		TUCSON (N)	AZ	85705	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-1381	2555 WEST APACHE TRAIL		APACHE JUNCTION	AZ	85120	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-1381	2555 WEST APACHE TRAIL		APACHE JUNCTION	AZ	85120	07/01/2019
CH090030	WAL-MART PHARMACY 10-1512	800 WEST WARNER ROAD		CHANDLER	AZ	85225	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-1646	6131 EAST SOUTHERN AVENUE		MESA	AZ	85206	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-1746	1380 WEST ELLIOTT ROAD		TEMPE	AZ	85284	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-2482	857 N DOBSON		MESA	AZ	85201	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-2671	1175 SOUTH ARIZONA AVENUE		CHANDLER	AZ	85286	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-2767	4505 E MCKELLIPS RD		MESA	AZ	85215	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-2768	1955 SO. STAPLEY DRIVE		MESA	AZ	85204	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-2778	1695 NO. ARIZONA BLVD		COOLIDGE	AZ	85128	03/05/2012
CH090030	WAL-MART PHARMACY 10-3357	3925 EAST GRANT ROAD		TUCSON(ALVERNON)	AZ	85712	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-3360	2750 E. GERMANN ROAD		CHANDLER	AZ	85286	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-3751	1725 WEST HUNT HIGHWAY		SAN TAN VALLEY	AZ	85143	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-3751	1725 WEST HUNT HIGHWAY		SAN TAN VALLEY	AZ	85143	07/01/2019
CH090030	WAL-MART PHARMACY 10-3799	240 WEST BASELINE ROAD		MESA	AZ	85210	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-3833	1606 SOUTH SIGNAL BUTTE ROAD		MESA	AZ	85209	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-3833	1606 SOUTH SIGNAL BUTTE ROAD		MESA	AZ	85209	07/01/2019
CH090030	WAL-MART PHARMACY 10-4430	41650 W MARICOPA CASA GRANDE		MARICOPA	AZ	85138	03/05/2012
CH090030	WAL-MART PHARMACY 10-4451	21055 SOUTH RITTENHOUSE DRIVE		QUEEN CREEK	AZ	85142	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-5186	2501 SOUTH MARKET STREET		GILBERT	AZ	85295	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/01/2021
CH090030	WAL-MART PHARMACY 10-5428	1710 SOUTH GREENFIELD ROAD		MESA(GREENFIELD)	AZ	85206	10/01/2015	05/02/2016
CH090030	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2017
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 03447	12965 N ORACLE RD	TUCSON	AZ	85739	11/25/2011
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 04344	1514 E FLORENCE BLVD	CASA GRANDE	AZ	85122	11/25/2011
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 06129	2021 N PINAL AVE	CASA GRANDE	AZ	85122	11/25/2011
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 09264	21274 N JOHN WAYNE PKWY	MARICOPA	AZ	85139	11/25/2011
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 09652	1575 N ARIZONA BLVD	COOLIDGE	AZ	85128	11/25/2011
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS #10505	2785 N. PINAL AVE	CASA GRANDE	AZ	85122	11/25/2011
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS #10998	2483 E FLORENCE BLVD	CASA GRANDE	AZ	85194	11/25/2011
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 06411	11951 N 1ST AVE	ORO VALLEY	AZ	85737-8787	04/01/2014
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 01076	333 E HUNT HIGHWAY	QUEEN CREEK	AZ	85143	10/01/2017
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 04188	55 W. APACHE TRAIL	APACHE JUNCTION	AZ	85120	10/01/2017
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 04793	1975 S ALMA SCHOOL RD	CHANDLER	AZ	85286	10/01/2017
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 06333	2440 S IRONWOOD DRIVE	APACHE JUNCTION	AZ	85120	10/01/2017
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 07723	975 E OCOTILLO RD	CHANDLER	AZ	85249	10/01/2017
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS # 02963	11545 E APACHE TRAIL	APACHE JUNCTION	AZ	85120	10/01/2019
CH090030	WALGREEN ARIZONA DRUG CO.	DBA: WALGREENS #21293	41840 W MARICOPA CASA GRANDE HWY	MARICOPA	AZ	85138	07/01/2021
CH090030	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	10/01/2021
CH090030	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2014	07/06/2015
CH090030	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2019
CH090030	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2019	10/01/2021
CH090030	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2019
CH090030	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2019
CH090030	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH090030	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Change Request	10032 E Southern Avenue STE 101 Mesa, AZ 85209	10032 E Southern Avenue Mesa, AZ 85209	5/28/2025 7:22 AM
Details	Entity Subname	Update	Change Request	Sun Life Health Mesa	Sun Life Health - Mesa Family Practice	5/28/2025 7:22 AM
Details	Last Recertification Date	Update	Recertification	2/6/2024 4:29:56 PM	3/4/2025 6:58:36 AM	3/4/2025 6:58 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/6/2024 4:29 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		106103	2/6/2024 4:29 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/6/2024 4:29 PM
Details	Last Recertification Date	Update	Recertification	2/7/2023 9:52:06 AM	2/6/2024 4:29:56 PM	2/6/2024 4:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		039885	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		572325	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		494576	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		341643	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		088592	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		304914	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		085022	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		105273	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		912044	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		474518	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		183991	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		912404	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		912431	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		912549	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		912107	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		912512	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		11694	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		912440	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		102639	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		011694	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		315835	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		104663	2/7/2023 9:52 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1275693947	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1609186386	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1851457295	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1063887149	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1043740566	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1528678000	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1871250910	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1891913166	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1063999837	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1881073443	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1588876429	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1033321989	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1467666206	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1417286568	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1902018856	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548690332	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548472475	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1902278252	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1992166359	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1396275459	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1639831985	2/7/2023 9:52 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	2/7/2023 9:52 AM
Details	Last Recertification Date	Update	Recertification	2/17/2022 5:12:09 PM	2/7/2023 9:52:06 AM	2/7/2023 9:52 AM
Addresses	Main Address	Update	Change Request	2080 W Southern Avenue Apache Junction, AZ 85120	10032 E Southern Avenue STE 101 Mesa, AZ 85209	12/19/2022 4:27 PM
Addresses	Shipping Address	Delete	Change Request	Sun Life Family Health Center, Inc. 2080 W Southern Avenue Apache Junction, AZ 85120		12/19/2022 4:27 PM
Addresses	Shipping Address	Delete	Change Request	Sun Life Family Health Center Pharmacy 2080 W Southern Avenue Apache Junction, AZ 85120		12/19/2022 4:27 PM
Details	Entity Subname	Update	Change Request	Apache Junction Satellite	Sun Life Health Mesa	12/19/2022 4:27 PM
Details	Last Recertification Date	Update	Recertification	2/24/2021 11:38:30 AM	2/17/2022 5:12:09 PM	2/17/2022 5:12 PM
Contacts	Authorizing Official	Update	Group Change Request	ROBINETTE, TRAVIS CEO Sun Life Family Health Center, Inc. 5208363446-2303	Estrada, Eddie Chief Executive Officer Sun Life Family Health Center 5208363446	11/30/2021 4:46 PM
Medicaid Billing	NPI: State	Update	Recertification		AZ	2/24/2021 11:38 AM
Medicaid Billing	NPI: State	Update	Recertification		AZ	2/24/2021 11:38 AM
Medicaid Billing	NPI: State	Update	Recertification		AZ	2/24/2021 11:38 AM
Details	Last Recertification Date	Update	Recertification	2/3/2020 11:33:52 AM	2/24/2021 11:38:30 AM	2/24/2021 11:38 AM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/24/2021 11:38 AM
Details	Last Recertification Date	Update	Recertification	2/4/2019 1:37:14 PM	2/3/2020 11:33:52 AM	2/3/2020 11:33 AM
Details	Last Recertification Date	Update	Recertification	2/12/2018 1:45:39 PM	2/4/2019 1:37:14 PM	2/4/2019 1:37 PM
Details	Last Recertification Date	Update	Recertification	2/10/2017 12:00:00 AM	2/12/2018 1:45:39 PM	2/12/2018 1:45 PM
Contacts	Authorizing Official	Update		ROBINETTE, TRAVIS CEO 5208363446-2303	ROBINETTE, TRAVIS CEO Sun Life Family Health Center, Inc. 5208363446-2303	10/16/2017 3:15 PM
Contacts	Signed By	Update		ROBINETTE, TRAVIS CEO 5208363446-2303	ROBINETTE, TRAVIS CEO Sun Life Family Health Center, Inc. 5208363446-2303	10/16/2017 3:15 PM
Contacts	Primary Contact	Update		Bertsch, Matthew Director of Pharmacy 5203810363	Bertsch, Matthew Director of Pharmacy Sun Life Family Health Center, INC 5203810363	9/28/2017 1:26 PM
Contacts	Primary Contact	Update		PROVENCIO, VICTOR PHARMACY DIRECTOR 5203810363	Bertsch, Matthew Director of Pharmacy 5203810363	8/3/2017 7:33 AM
Contacts	Authorizing Official	Insert			ROBINETTE, TRAVIS CEO 5208363446-2303	7/17/2017 2:44 PM
Contacts	Signed By	Insert			ROBINETTE, TRAVIS CEO 5208363446-2303	7/17/2017 2:44 PM
Addresses	Main Address	Insert			2080 W Southern Avenue Apache Junction, AZ 85120	3/20/2017 1:50 PM
Addresses	Billing Address	Insert			Sun Life Family Health Center, INC PO Box 10097 Casa Grande, AZ 85130	3/20/2017 1:50 PM
Addresses	Shipping Address	Insert			Sun Life Family Health Center, Inc. 2080 W Southern Avenue Apache Junction, AZ 85120	3/20/2017 1:50 PM
Addresses	Shipping Address	Insert			Sun Life Family Health Center Pharmacy 2080 W Southern Avenue Apache Junction, AZ 85120	3/20/2017 1:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/10/2017 7:07 PM
Medicaid Billing	Medicaid: Number	Insert			011702	2/10/2017 7:07 PM
Medicaid Billing	Medicaid: State	Insert			AZ	2/10/2017 7:07 PM
Medicaid Billing	NPI: Number	Insert			1508276940	2/10/2017 7:07 PM
Medicaid Billing	NPI: Number	Insert			1689778623	2/10/2017 7:07 PM
Details	Last Recertification Date	Update		3/1/2016 12:00:00 AM	2/10/2017 12:00:00 AM	2/10/2017 7:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	3/1/2016 11:26 AM
Medicaid Billing	Medicaid: Number	Insert			920306	3/1/2016 11:26 AM
Medicaid Billing	Medicaid: State	Insert			AZ	3/1/2016 11:26 AM
Medicaid Billing	NPI: Number	Insert			1699176354	3/1/2016 11:26 AM
Details	Last Recertification Date	Update		1/28/2015 12:00:00 AM	3/1/2016 12:00:00 AM	3/1/2016 11:26 AM
Contacts	Primary Contact	Insert			PROVENCIO, VICTOR PHARMACY DIRECTOR 5203810363	7/9/2015 1:10 PM
Details	Last Recertification Date	Update			1/28/2015 12:00:00 AM	1/28/2015 2:57 PM
Dates	Participating Approval Date	Update			7/23/2014 12:00:00 AM	7/23/2014 2:53 PM
Details	State	Update		Pending	Active	7/23/2014 2:53 PM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	7/23/2014 2:53 PM
Details	340B ID	Update		ONLINE_REG_44801	CH09003L	7/23/2014 6:01 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_44801	7/9/2014 1:40 PM
Details	Last Recertification Date	Insert				7/9/2014 1:40 PM
Details	Grant Number	Insert			H80CS00466	7/9/2014 1:40 PM
Details	340B ID	Insert			ONLINE_REG	7/9/2014 1:40 PM
Details	Is Authorizing Official EHB Data	Insert			False	7/9/2014 1:40 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/9/2014 1:40 PM
Details	Medicare Provider Number	Insert				7/9/2014 1:40 PM
Details	Entity Name	Insert			SUN LIFE FAMILY HEALTH CENTER, INC.	7/9/2014 1:40 PM
Details	Program Code	Insert			CH	7/9/2014 1:40 PM
Details	Entity Subname	Insert			Apache Junction Satellite	7/9/2014 1:40 PM
Dates	Participating Approval Date	Insert				7/9/2014 1:40 PM
Details	State	Insert			Pending	7/9/2014 1:40 PM
Dates	Registration Date	Insert			7/9/2014 12:00:00 AM	7/9/2014 1:40 PM
Dates	Signed By Date	Insert			7/9/2014 12:00:00 AM	7/9/2014 1:40 PM
Dates	Start Date	Insert				7/9/2014 1:40 PM
Terminations	Termination Comments	Insert				7/9/2014 1:40 PM
Terminations	Termination Date	Insert				7/9/2014 1:40 PM
Terminations	Termination Effective Date	Insert				7/9/2014 1:40 PM
Terminations	Termination Reason	Insert				7/9/2014 1:40 PM

340B Drug Pricing Program Database