Covered Entity Details

PED063301-23 Children's Hospital Colorado (Active) - information as of 5/13/2025 1:43:21 AM

Main Details

Name

Children's Hospital Colorado

Subdivision Name

Southeast Aurora Orthopedic Care

Type

Children's Hospital

Rural

340B ID

PED063301-23

Medicare Provider Number

063301

Outpatient Facility Provider Number

063301

Additional Details

Current Program Status

Active

Registration Date

7/14/2014

Participating Start Date

10/1/2014

Participating Approval Date

9/8/2014

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

23770 E. Smoky Hill Rd.
Aurora, CO 80016

Billing Address

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

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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	9000168325	1750742359,1952762551

Shipping Addresses

Shipping Address 1

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

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
PED063301-01	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - North Campus Urgent Care	469 State Highway 7	Broomfield	CO	Active
PED063301-02	Child	PED	Children's Hospital Colorado	Urgent Care Uptown Denver	1830 Franklin Street	Denver	CO	Active
PED063301-03	Child	PED	THE CHILDREN'S HOSPITAL ASSOCIATION	Children's Hospital Colorado - Littleton Oncology Clinic	13123 East 16th Avenue	Aurora	CO	Terminated
PED063301-04	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - Parker Physical Therapy	19284 Cottonwood Dr	Parker	CO	Active
PED063301-05	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - Broomfield Physical Therapy	8401 Arista Place	Broomfield	CO	Active
PED063301-06	Child	PED	THE CHILDREN'S HOSPITAL ASSOCIATION	Children's Hospital Colorado - Memorial Printers Park Peds PT- Outpatient	175 S Union Blvd	Colorado Springs	CO	Terminated
PED063301-07	Child	PED	THE CHILDREN'S HOSPITAL ASSOCIATION	Children's Hospital Colorado - Pueblo Speech Pathology	704 Fortino Blvd	Pueblo	CO	Terminated
PED063301-08	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - KidStreet Therapy Care	860 North Potomac Circle	Aurora	CO	Active
PED063301-09	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - Centennial Orthopedic Care	9094 E Mineral Ave	Centennial	CO	Active
PED063301-10	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - Village Pavilion 3rd Floor Clinics	860 N Potomac Circle	Aurora	CO	Terminated
PED063301-100	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - North Campus Genetics - North Campus Genetics	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-101	Child	PED	Children's Hospital Colorado	Southeast Aurora Genetics	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-102	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Campus Lifestyle Medicine - North Campus Lifestyle Medicine	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-103	Child	PED	Children's Hospital Colorado	Southeast Aurora ENT	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-104	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - North Campus Plastic Surgery - North Campus Plastic Surgery	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-105	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - South Campus Nephrology Clinic - South Campus Nephrology Clinic	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-106	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Campus Nephrology Clinic - North Campus Nephrology Clinic	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-107	Child	PED	Children's Hospital Colorado	Southeast Aurora Endocrinology	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-108	Child	PED	Children's Hospital Colorado	Southeast Aurora Neurology	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-109	Child	PED	Children's Hospital Colorado	Southeast Aurora Gastro	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-11	Child	PED	Children's Hospital Colorado	Southeast Aurora Clinics	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-110	Child	PED	Children's Hospital Colorado	Southeast Aurora Urology	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-111	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - Maternal Fetal Care North - Maternal Fetal Care North	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-112	Child	PED	Children's Hospital Colorado	Southeast Aurora Gynecology	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-113	Child	PED	Children's Hospital Colorado	Southeast Aurora Urgent Care	23770 E. Smoky Hill Rd	Aurora	CO	Active
PED063301-12	Child	PED	THE CHILDREN'S HOSPITAL ASSOCIATION	Children's Hospital Colorado - Centennial OP Specialty Care	13123 East 16th Avenue	Aurora	CO	Terminated
PED063301-13	Child	PED	THE CHILDREN'S HOSPITAL ASSOCIATION	Children's Hospital Colorado - Briargate COS OP Specialty Care	4125 Briargate Parkway	Colorado Springs	CO	Terminated
PED063301-14	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - Urgent Care Wheat Ridge	3455 Lutheran Pkwy	Wheat Ridge	CO	Active
PED063301-15	Child	PED	THE CHILDREN'S HOSPITAL ASSOCIATION	Children's Hospital Colorado - Littleton Physical Therapy	151 West County Line Rd	Littleton	CO	Terminated
PED063301-16	Child	PED	THE CHILDREN'S HOSPITAL ASSOCIATION	Children's Hospital Colorado - Briargate COS Orthopedic Care	4125 Briargate Parkway	Colorado Springs	CO	Terminated
PED063301-17	Child	PED	THE CHILDREN'S HOSPITAL ASSOCIATION	Children's Hospital Colorado - Briargate Oncology Clinic	4125 Briargate Parkway	Colorado Springs	CO	Terminated
PED063301-18	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - Uptown Clinics	1830 Franklin St.	Denver	CO	Active
PED063301-19	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado / Uptown Orthopedic Care	1830 Franklin St	Denver	CO	Active
PED063301-20	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - North Campus OP Specialty Care	469 State Highway 7	Broomfield	CO	Active
PED063301-21	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - North Campus Orthopedic Care	469 State Highway 7	Broomfield	CO	Active
PED063301-22	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - North Campus Sports Therapy	469 State Highway 7	Broomfield	CO	Active
PED063301-23	Child	PED	Children's Hospital Colorado	Southeast Aurora Orthopedic Care	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-24	Child	PED	Children's Hospital Colorado	Southeast Aurora Sports Therapy	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-25	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - South Campus CCBD	1811 Plaza Dr	Highlands Ranch	CO	Active
PED063301-26	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - South Campus Level 4 OP Specialty	1811 Plaza Dr	Highlands Ranch	CO	Terminated
PED063301-27	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - South Campus Level 3 OP Specialty	1811 Plaza Dr	Highlands Ranch	CO	Active
PED063301-28	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - South Campus Radiology	1811 Plaza Dr	Highlands Ranch	CO	Active
PED063301-29	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - South Campus Sports Therapy	1811 Plaza Dr	Highlands Ranch	CO	Active
PED063301-30	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - South Campus Surgery	1811 Plaza Dr	Highlands Ranch	CO	Active
PED063301-31	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - South Campus Urgent Care	1811 Plaza Dr	Highlands Ranch	CO	Active
PED063301-32	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - Outpatient Specialty Care Wheat Ridge	3455 Lutheran Pkwy	Wheat Ridge	CO	Active
PED063301-33	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - Wheat Ridge Orthopedic Care	3455 Lutheran Pkwy	Wheat Ridge	CO	Active
PED063301-34	Child	PED	THE CHILDREN'S HOSPITAL ASSOCIATION	CHILDRENS HOSPITAL COLORADO / Wheatridge Gastro	469 WEST STATE HIGHWAY 7	BROOMFIELD	CO	Terminated
PED063301-35	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / Wheat Ridge Ado Family	3455 LUTHERAN PARKWAY SUITE 230	WHEAT RIDGE	CO	Active
PED063301-36	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / Wheat Ridge ENT	3455 Lutheran Pkwy	WHEAT RIDGE	CO	Active
PED063301-37	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / North Campus Allergy	469 State Highway 7	BROOMFIELD	CO	Active
PED063301-38	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / North Campus ENT	469 State Highway 7	BROOMFIELD	CO	Active
PED063301-39	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / North Campus Dermatology	469 WEST STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-40	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / Uptown Rehab Clinic	1830 FRANKLIN STREET	DENVER	CO	Active
PED063301-41	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / Uptown ENT	1830 Franklin Street	DENVER	CO	Active
PED063301-42	Child	PED	Children's Hospital Colorado	Southeast Aurora Allergy	23770 E. Smoky Hill Rd.	Aurora	CO	Active
PED063301-43	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado / Child Health Clinic HP	860 N Potomac Circle	Aurora	CO	Active
PED063301-44	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado / CO Ado Maternity PR HP	860 N Potomac Circle	Aurora	CO	Active
PED063301-45	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado / Ado Medicine Clinic HP	860 N Potomac Circle	Aurora	CO	Active
PED063301-46	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado / Eye Clinic HP	860 N Potomac Circle	Aurora	CO	Active
PED063301-47	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado / Young Mothers HP	860 N Potomac Circle	Aurora	CO	Active
PED063301-48	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado / Ado Family Planning HP	860 N Potomac Circle	Aurora	CO	Active
PED063301-49	Child	PED	THE CHILDREN'S HOSPITAL ASSOCIATION	CHILDRENS HOSPITAL COLORADO / Broomfield OP Specialty Care	8401 ARISTA PLACE	BROOMFIELD	CO	Terminated
PED063301-50	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / Broomfield Rehab Psych	8401 ARISTA PLACE	BROOMFIELD	CO	Active
PED063301-51	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Eye Clinic	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-52	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Rehab Clinic	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-53	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Urology	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-54	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Endo	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-55	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South BDC	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-56	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Gynecology	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-57	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Dermatology	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-58	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Gastro	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-59	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Ado Family	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-60	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Allergy	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-61	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South ENT	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-62	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Campus Rehab Psych	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-63	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Ortho	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-64	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Neurology	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-65	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO / South Campus Cardiology	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-66	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - Parker Emergency Department	9395 CROWN CREST BOULEVARD	PARKER	CO	Terminated
PED063301-67	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - Uptown Sleep Lab	1830 N FRANKLIN ST	DENVER	CO	Active
PED063301-68	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Campus Pediatric Surgery Clinic	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-69	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - Uptown Gastro	1830 N FRANKLIN ST	DENVER	CO	Active
PED063301-70	Child	PED	Children's Hospital Colorado	CHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion Wellness Center	860 N POTOMAC CIRCLE	AURORA	CO	Active
PED063301-71	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Pulmonary	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-72	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Campus Radiology	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-73	Child	PED	Children's Hospital Colorado	CHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion Outpatient Physical Therapy	860 N POTOMAC CIRCLE	AURORA	CO	Active
PED063301-74	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - Uptown Cardiology Clinic	1830 N FRANKLIN ST	DENVER	CO	Active
PED063301-75	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - Uptown Allergy	1830 N FRANKLIN ST	DENVER	CO	Active
PED063301-76	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Urology	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-77	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Campus Rehab Clinic	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-78	Child	PED	Children's Hospital Colorado	CHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion TRUE Center	860 N POTOMAC CIRCLE	AURORA	CO	Active
PED063301-79	Child	PED	Children's Hospital Colorado	CHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion Orthopedic Clinic	860 N POTOMAC CIRCLE	AURORA	CO	Active
PED063301-80	Child	PED	Children's Hospital Colorado	CHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion Eye Care CO	860 N POTOMAC CIRCLE	AURORA	CO	Active
PED063301-81	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - Uptown Endocrinology	1830 N FRANKLIN ST	DENVER	CO	Active
PED063301-82	Child	PED	Children's Hospital Colorado	CHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion Pulmonary Clinic	860 N POTOMAC CIRCLE	AURORA	CO	Active
PED063301-83	Child	PED	Children's Hospital Colorado	CHILDREN'S COLORADO - HEALTH PAVILI - Health Pavilion CHIP Youth Program	860 N POTOMAC CIRCLE	AURORA	CO	Active
PED063301-84	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Campus Endocrinology	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-85	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - South Pulmonary	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-86	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Cardiology	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-87	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - Wheat Ridge Cardiology	3455 LUTHERAN PKWY	WHEAT RIDGE	CO	Active
PED063301-88	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - Wheat Ridge Dermatology	3455 LUTHERAN PKWY	WHEAT RIDGE	CO	Active
PED063301-89	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - Wheat Ridge Endocrinology	3455 LUTHERAN PKWY	WHEAT RIDGE	CO	Active
PED063301-90	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Campus CCBD Infusion	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-91	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - Wheat Ridge Gastro	3455 LUTHERAN PKWY	WHEAT RIDGE	CO	Active
PED063301-92	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - South Rheumatology	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-93	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Gastro	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-94	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - South Campus Sleep Lab	1811 PLAZA DRIVE	HIGHLANDS RANCH	CO	Active
PED063301-95	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - North Campus Eye Clinic	469 State Highway 7	Broomfield	CO	Active
PED063301-96	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - North Campus Rheumatology	469 State Highway 7	Broomfield	CO	Active
PED063301-97	Child	PED	Children's Hospital Colorado	Children's Hospital Colorado - North Campus Gynecology	469 State Highway 7	Broomfield	CO	Active
PED063301-98	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Campus Neurology	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active
PED063301-99	Child	PED	Children's Hospital Colorado	CHILDRENS HOSPITAL COLORADO - North Campus Adolescent Family Planning	469 STATE HIGHWAY 7	BROOMFIELD	CO	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Entity Subname	Update	Change Request	Children's Hospital Colorado - Parker Orthopedic Care	Southeast Aurora Orthopedic Care	4/30/2025 1:45 PM
Addresses	Main Address	Update	Group Change Request	9399 Crown Crest Blvd Suite 300 Parker, CO 80138	23770 E. Smoky Hill Rd. Aurora, CO 80016	9/16/2024 7:42 AM
Details	Last Recertification Date	Update	Recertification	8/23/2023 2:33:34 PM	9/4/2024 5:28:35 PM	9/4/2024 5:28 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1952762551	12/8/2023 4:47 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	12/8/2023 4:47 PM
Details	Last Recertification Date	Update	Recertification	9/12/2022 9:59:12 AM	8/23/2023 2:33:34 PM	8/23/2023 2:33 PM
Details	Last Recertification Date	Update	Recertification	9/6/2021 1:51:45 PM	9/12/2022 9:59:12 AM	9/12/2022 9:59 AM
Details	Last Recertification Date	Update	Recertification	9/8/2020 3:48:40 PM	9/6/2021 1:51:45 PM	9/6/2021 1:51 PM
Contacts	Primary Contact	Update	Profile Change Request	Laremont, Ricardo Alexis Pharmacy 340B Coordinator Children's Hospital Colorado 7207778899	Laremont, Ricardo Alexis Pharmacy 340B Program Manager Children's Hospital Colorado 7207778899	6/23/2021 11:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/8/2020 3:48 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		9000168325	9/8/2020 3:48 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CO	9/8/2020 3:48 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	9000168326 (CO)		9/8/2020 3:48 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1750742359	9/8/2020 3:48 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/8/2020 3:48 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1952762551 ( )		9/8/2020 3:48 PM
Details	Last Recertification Date	Update	Recertification	9/15/2019 7:42:49 PM	9/8/2020 3:48:40 PM	9/8/2020 3:48 PM
Contacts	Primary Contact	Update	Profile Change Request	Laremont, Ricardo Alexis Pharmacy 340B Coordinator The Childrens Hospital Association 7207778899	Laremont, Ricardo Alexis Pharmacy 340B Coordinator Children's Hospital Colorado 7207778899	1/14/2020 2:07 PM
Addresses	Main Address	Update	Recertification	9399 Crown Crest Blvd Sierra Medical Office Bldg; Suite 300 Parker, CO 80138	9399 Crown Crest Blvd Suite 300 Parker, CO 80138	9/15/2019 7:42 PM
Medicaid Billing	Medicaid: Number	Update	Recertification	05002043	9000168326	9/15/2019 7:42 PM
Medicaid Billing	NPI: Number	Update	Recertification	1336245828	1952762551	9/15/2019 7:42 PM
Details	Last Recertification Date	Update	Recertification	9/10/2018 12:10:35 PM	9/15/2019 7:42:49 PM	9/15/2019 7:42 PM
Details	Entity Subname	Update	Recertification	Children's Hospital Colorado - Parker Sports Medicine	Children's Hospital Colorado - Parker Orthopedic Care	9/15/2019 7:42 PM
Details	Entity Name	Update	Recertification	THE CHILDREN'S HOSPITAL ASSOCIATION	Children's Hospital Colorado	9/15/2019 8:39 AM
Contacts	Authorizing Official	Update	AO Change Request	Milton, Jerrod Senior Vice President Professional & Support Services Children's Hospital Colorado 7207772839	Dugan, Casey Vice President of Pharmacy Services Children's Hospital Colorado 7207775683	8/28/2019 1:17 PM
Contacts	Authorizing Official	Update	Profile Change Request	Milton, Jerrod VP Operations Children's Hospital Colorado 7207772839	Milton, Jerrod Senior Vice President Professional & Support Services Children's Hospital Colorado 7207772839	8/28/2019 11:16 AM
Contacts	Signed By	Update	Profile Change Request	Milton, Jerrod VP Operations Children's Hospital Colorado 7207772839	Milton, Jerrod Senior Vice President Professional & Support Services Children's Hospital Colorado 7207772839	8/28/2019 11:16 AM
Details	Last Recertification Date	Update	Recertification	12/5/2017 1:10:01 PM	9/10/2018 12:10:35 PM	9/10/2018 12:10 PM
Details	Entity Subname	Update	Recertification	Children's Hospital Colorado - Parker Orthopaedic Care	Children's Hospital Colorado - Parker Sports Medicine	9/10/2018 12:10 PM
Details	Last Recertification Date	Update	Recertification	9/7/2016 12:00:00 AM	12/5/2017 1:10:01 PM	12/5/2017 1:10 PM
Contacts	Authorizing Official	Update		Milton, Jerrod VP Operations 7207772839	Milton, Jerrod VP Operations Children's Hospital Colorado 7207772839	10/20/2017 11:24 AM
Contacts	Signed By	Update		Milton, Jerrod VP Operations 7207772839	Milton, Jerrod VP Operations Children's Hospital Colorado 7207772839	10/20/2017 11:24 AM
Contacts	Primary Contact	Update	Profile Change Request	Laremont, Ricardo Alexis Pharmacy 340B Coordinator The Childrens Hospital Association 3038177257	Laremont, Ricardo Alexis Pharmacy 340B Coordinator The Childrens Hospital Association 7207778899	9/25/2017 12:04 PM
Contacts	Primary Contact	Update		Laremont, Ricardo Pharmacy 340B Coordinator 3038177257	Laremont, Ricardo Alexis Pharmacy 340B Coordinator The Childrens Hospital Association 3038177257	9/25/2017 11:57 AM
Contacts	Authorizing Official	Insert			Milton, Jerrod VP Operations 7207772839	7/26/2017 11:51 AM
Contacts	Signed By	Insert			Milton, Jerrod VP Operations 7207772839	7/26/2017 11:51 AM
Contacts	Primary Contact	Update		Dugan, Casey DIRECTOR OF PHARMACY 7207775683	Laremont, Ricardo Pharmacy 340B Coordinator 3038177257	9/27/2016 2:12 PM
Addresses	Main Address	Insert			9399 Crown Crest Blvd Sierra Medical Office Bldg; Suite 300 Parker, CO 80138	9/7/2016 7:07 AM
Addresses	Shipping Address	Insert			Children's Hospital Colorado 13123 E 16th Av Aurora, CO 80045	9/7/2016 7:07 AM
Medicaid Billing	NPI: Number	Insert			1336245828	9/7/2016 7:07 AM
Details	Last Recertification Date	Update		9/8/2015 12:00:00 AM	9/7/2016 12:00:00 AM	9/7/2016 7:07 AM
Contacts	Primary Contact	Insert			Dugan, Casey DIRECTOR OF PHARMACY 7207775683	9/7/2016 7:07 AM
Addresses	Billing Address	Insert			Children's Hospital Colorado 13123 E 16th Av Aurora, CO 80045	8/8/2016 1:15 PM
Details	Last Recertification Date	Update			9/8/2015 12:00:00 AM	9/9/2015 1:38 PM
Details	Entity Subname	Update		Children's Hospital Colorado - Parker Orthopaedic Care / Parker Orthopaedic Care	Children's Hospital Colorado - Parker Orthopaedic Care	12/31/2014 3:51 PM
Details	Entity Subname	Update		Children's Hospital Colorado - Parker Orthopaedic Care	Children's Hospital Colorado - Parker Orthopaedic Care / Parker Orthopaedic Care	12/19/2014 2:16 PM
Dates	Participating Approval Date	Update			9/8/2014 12:00:00 AM	9/8/2014 10:02 AM
Details	State	Update		Pending	Active	9/8/2014 10:02 AM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	9/8/2014 10:02 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_45718	PED063301-23	9/6/2014 7:23 AM
Details	Entity Subname	Update		Children's Hospital Colorado	Children's Hospital Colorado - Parker Orthopaedic Care	9/6/2014 7:23 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_45718	7/14/2014 7:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/14/2014 7:32 PM
Medicaid Billing	Medicaid: Number	Insert			05002043	7/14/2014 7:32 PM
Medicaid Billing	Medicaid: State	Insert			CO	7/14/2014 7:32 PM
Details	Last Recertification Date	Insert				7/14/2014 7:32 PM
Details	Grant Number	Insert				7/14/2014 7:32 PM
Details	340B ID	Insert				7/14/2014 7:32 PM
Details	Is Authorizing Official EHB Data	Insert				7/14/2014 7:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/14/2014 7:32 PM
Details	Medicare Provider Number	Insert			063301	7/14/2014 7:32 PM
Details	Entity Name	Insert			THE CHILDREN'S HOSPITAL ASSOCIATION	7/14/2014 7:32 PM
Details	Program Code	Insert			PED	7/14/2014 7:32 PM
Details	Entity Subname	Insert			Children's Hospital Colorado	7/14/2014 7:32 PM
Dates	Participating Approval Date	Insert				7/14/2014 7:32 PM
Details	State	Insert			Pending	7/14/2014 7:32 PM
Dates	Registration Date	Insert			7/14/2014 12:00:00 AM	7/14/2014 7:32 PM
Dates	Signed By Date	Insert			7/14/2014 12:00:00 AM	7/14/2014 7:32 PM
Dates	Start Date	Insert				7/14/2014 7:32 PM
Terminations	Termination Comments	Insert				7/14/2014 7:32 PM
Terminations	Termination Date	Insert				7/14/2014 7:32 PM
Terminations	Termination Effective Date	Insert				7/14/2014 7:32 PM
Terminations	Termination Reason	Insert				7/14/2014 7:32 PM