340B Drug Pricing Program Database


CH08006AD DENVER HEALTH AND HOSPITAL AUTHORITY (Terminated) - information as of 5/14/2025 10:56:29 PM

Main Details
DENVER HEALTH AND HOSPITAL AUTHORITY
DENVER HEALTH MEDICAL CAMPUS
HRSA-Funded Health Center
BPS-H80-003213
CH08006AD
H80CS00218


Additional Details
Terminated
10/1/2015
1/1/2016
10/23/2015
1/30/2024

4/1/2025
Other

Contacts

Denver Health and Hospital Authority
Rebecca Hanratty, Chief Ambulatory Officer
(303) 602-6397

Denver Health and Hospital Authority
Nathalie Seoldo-Hinman, Admin Director of Pharmacy Services
(303) 602-9211

Addresses

777 BANNOCK ST
DENVER, CO 80204-4507

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CO31172326,04019220,05011002,77735072,28970845,03002334,03295003,03498441,03002631,03948502,07032382,28358562,39492788,9000181762,9000178555,9000180108,9000189609,71135065,05050083,49471091,05638598,05638382,05050117,05900139,05050091,05050133,55720536,9000197664,9000199110,82201722,9000181596,17352380,11904241,05638770,92724728,33522731,39577856,05638812,05638804,05638846,05638788,05638796,30406871,05638820,94051721,52889564,84609354,9000191389,9000191390,9000191391,9000191392,9000191394,9000191393,9000178521,9000178404,9000181909,9000178592,7032382,9000154134,676300571811919566,1477746105,1689624686,1255470795,1033254925,1982627493,1285657528,1316960586,1720002181,1083637326,1174819197,1811328032,1164883955,1023464906,1295293579,1497305270,1598314528,1174158992,1992161780,1285675371,1467877126,1316988413,1194766428,1326089400,1922049014,1801837810,1619918794,1841231990,1184202897,1669144382,1336252287,1376197400,1528337755,1467830778,1982626750,1427161371,1386714095,1144242900,1255353025,1366760498,1811196959,1376565143,1093737868,1326311655,1437171204,1184794893,1114341963,1538181318,1417979170,1275957029,1225343379,1740641521,1326060088,1447895693,1265077416,1356986509,1982249132,1427155373,1629175153,1538266069,1124123427,1891891107,1033214333,1952699498,1306042502,1215987987
Shipping Addresses

Denver Health Acute Pharmacy
790 Delaware St
Denver, CO 80204

Central Fill Pharmacy
500 QUIVAS ST
STE A
Denver, CO 80204

Denver Health Pharmacy at Bernard F. Gibson Eastside Family Health Center
501 28th St.
Denver, CO 80205

Denver Health Pharmacy at La Casa/Quigg Newton Family Health Center
4545 Navajo St.
Denver, CO 80211

Denver Health Pharmacy at Lowry Family Health Center
1001 Yosemite St
Denver, CO 80230

Denver Health Pharmacy at Montbello Family Health Center
12600 E. Albrook Dr
Denver, CO 80239

Denver Health Pharmacy at Federico F. Pena Southwest Family Health Center
1339 S. Federal Blvd.
Denver, CO 80219

Denver Health Pharmacy at Webb Center for Primary Care
301 W. 6th Ave.
Denver, CO 80204

Denver Health Pharmacy at Sam Sandos Westside Family Health Center
1100 Federal Blvd.
Denver, CO 80204

Denver Health Outpatient Medical Center
660 N Bannock St.
Denver, CO 80204
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH080060TerminatedBPS-H80-005410DENVER HEALTH AND HOSPITALS AUTHORITYDENVER HEALTH AND HOSPITALS660 Bannock St DenverCO
CH08006AActiveBPS-H80-004391DENVER HEALTH AND HOSPITAL AUTHORITYEASTSIDE FAMILY HEALTH CENTER501 28th St DenverCO
CH08006AAActiveBPS-H80-012411DENVER HEALTH AND HOSPITAL AUTHORITYManual Campus1700 E 28th Ave DenverCO
CH08006ABActiveBPS-H80-030107DENVER HEALTH AND HOSPITAL AUTHORITYSafe Center405 S Platte River Dr DenverCO
CH08006ACActiveBPS-H80-014027DENVER HEALTH AND HOSPITAL AUTHORITYThomas Jefferson High School3950 S Holly St DenverCO
CH08006ADTerminatedBPS-H80-003213DENVER HEALTH AND HOSPITAL AUTHORITYDENVER HEALTH MEDICAL CAMPUS777 BANNOCK ST DENVERCO
CH08006AEActiveBPS-H80-001209DENVER HEALTH AND HOSPITAL AUTHORITYMobile Health Clinic 1777 Bannock St DenverCO
CH08006AFActiveBPS-H80-015252DENVER HEALTH AND HOSPITAL AUTHORITYFlorence Crittenton Campus55 South Zuni Street DenverCO
CH08006AGActiveBPS-H80-017126DENVER HEALTH AND HOSPITAL AUTHORITYFederico F Pena Family Health Center1339 S Federal Blvd DenverCO
CH08006AHActiveBPS-H80-017509DENVER HEALTH AND HOSPITAL AUTHORITYPrimary Care Clinic at WellPower4455 E 12TH AVE DENVERCO
CH08006AJActiveBPS-H80-019065DENVER HEALTH AND HOSPITAL AUTHORITYWellington E. Webb Center for Primary Care301 W. 6th Ave DenverCO
CH08006AKActiveBPS-H80-027465DENVER HEALTH AND HOSPITAL AUTHORITYRose Andom Health Center1330 Fox St DenverCO
CH08006ALActiveBPS-H80-027984DENVER HEALTH AND HOSPITAL AUTHORITYEast High School-Based Health Center1600 City Park Esplanade DenverCO
CH08006AMTerminatedBPS-H80-021985DENVER HEALTH AND HOSPITAL AUTHORITYDenver Health and Hosptial601 N Broadway DenverCO
CH08006ANActiveBPS-H80-031067DENVER HEALTH AND HOSPITAL AUTHORITYSloan's Lake Primary Care Center4007 W Colfax Ave DenverCO
CH08006APTerminatedBPS-H80-031988DENVER HEALTH AND HOSPITALS AUTHORITYOutpatient Medical Center660 N. Bannock Street DenverCO
CH08006AQActiveBPS-H80-031480DENVER HEALTH AND HOSPITAL AUTHORITYMobile Health Center 2777 BANNOCK ST DENVERCO
CH08006ARActiveBPS-H80-032177DENVER HEALTH AND HOSPITAL AUTHORITYMobile Health Center 3777 BANNOCK ST DENVERCO
CH08006ASActiveBPS-H80-032555DENVER HEALTH AND HOSPITAL AUTHORITYDenver Health Primary Care Center660 N. Bannock St STE 7144 DenverCO
CH08006ATActiveBPS-H80-032553DENVER HEALTH AND HOSPITAL AUTHORITYObstetrics and Gynecology Clinic777 Bannock St Ste 1179 DenverCO
CH08006AUActiveBPS-H80-032554DENVER HEALTH AND HOSPITALS AUTHORITYAdult Urgent Care Clinic660 N. Bannock St STE 1057 DenverCO
CH08006AVActiveBPS-H80-032552DENVER HEALTH AND HOSPITAL AUTHORITYDermatology Clinic and Endocrinology Clinic660 N. Bannock St STE 5135 DenverCO
CH08006AWActiveBPS-H80-032556DENVER HEALTH AND HOSPITAL AUTHORITYAdult Dental and OMFS Clinic660 N. Bannock St STE 7770 DenverCO
CH08006AXActiveBPS-H80-032778DENVER HEALTH AND HOSPITAL AUTHORITYPediatric Emergency Department and Urgent Care777 Bannock St Ste 1364 DenverCO
CH08006AYActiveBPS-H80-033562DENVER HEALTH AND HOSPITAL AUTHORITYGeorge Washington Campus School-Based Health Center655 S Monaco Pkwy Ste 108 DenverCO
CH08006CActiveBPS-H80-012571DENVER HEALTH AND HOSPITAL AUTHORITYPARK HILL FAMILY HEALTH CENTER4995 E 33rd Ave DENVERCO
CH08006EActiveBPS-H80-003900DENVER HEALTH AND HOSPITAL AUTHORITYWESTSIDE FAMILY HEALTH CENTER1100 FEDERAL BLVD DENVERCO
CH08006FActiveBPS-H80-004208DENVER HEALTH AND HOSPITAL AUTHORITYLa Casa Quigg Newton Family Health Center4545 NAVAJO ST DENVERCO
CH08006HActiveBPS-H80-004510DENVER HEALTH AND HOSPITAL AUTHORITYWESTWOOD FAMILY HEALTH CENTER4320 W Alaska Pl DenverCO
CH08006JActiveBPS-H80-008864DENVER HEALTH AND HOSPITAL AUTHORITYMontbello Family Health Center12600 Albrook Dr DenverCO
CH08006KActiveBPS-H80-000543DENVER HEALTH AND HOSPITAL AUTHORITYLOWRY FAMILY HEALTH CENTER1001 YOSEMITE ST DENVERCO
CH08006LActiveBPS-H80-001322DENVER HEALTH AND HOSPITAL AUTHORITYJohn F. Kennedy High School2855 S. LAMAR ST DENVERCO
CH08006MActiveBPS-H80-001301DENVER HEALTH AND HOSPITAL AUTHORITYLake Campus1820 LOWELL BLVD DENVERCO
CH08006NActiveBPS-H80-003785DENVER HEALTH AND HOSPITAL AUTHORITYAbraham Lincoln Campus2285 S FEDERAL BLVD DENVERCO
CH08006PActiveBPS-H80-002447DENVER HEALTH AND HOSPITAL AUTHORITYMontbello Campus5000 CROWN BLVD DENVERCO
CH08006QActiveBPS-H80-003804DENVER HEALTH AND HOSPITAL AUTHORITYNorth Campus2960 N. SPEER BLVD DENVERCO
CH08006RActiveBPS-H80-002904DENVER HEALTH AND HOSPITAL AUTHORITYWest Campus951 ELATI ST DENVERCO
CH08006SActiveBPS-H80-003166DENVER HEALTH AND HOSPITAL AUTHORITYRachel B. Noel Campus5290 Kittredge St DenverCO
CH08006TActiveBPS-H80-002564DENVER HEALTH AND HOSPITAL AUTHORITYBruce Randolph Campus3955 Steele St DenverCO
CH08006UActiveBPS-H80-001927DENVER HEALTH AND HOSPITAL AUTHORITYKepner Campus911 S Hazel Ct DenverCO
CH08006VActiveBPS-H80-004833DENVER HEALTH AND HOSPITAL AUTHORITYSouth High School1700 E. LOUISANA STREET DENVERCO
CH08006WActiveBPS-H80-003752DENVER HEALTH AND HOSPITAL AUTHORITYKunsmiller Creative Arts Academy2250 S. Quitman Way DenverCO
CH08006XActiveBPS-H80-004078DENVER HEALTH AND HOSPITAL AUTHORITYMARTIN LUTHER KING JUNIOR EARLY COLLEGE CAMPUS19535 E. 46TH AVE DENVERCO
CH08006YActiveBPS-H80-012242DENVER HEALTH AND HOSPITAL AUTHORITYEvie Garrett Dennis Campus4800 Telluride St DenverCO
CH08006ZActiveBPS-H80-012335DENVER HEALTH AND HOSPITAL AUTHORITYPlace Bridge Academy7125 Cherry Creek Drive North DenverCO
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH08006AACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750212/21/2022  
CH08006AACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201012/21/2022  
CH08006AACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884912/21/2022  
CH08006AACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349212/21/2022  
CH08006AACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624112/21/2022  
CH08006AACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282212/21/2022  
CH08006AACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607512/21/2022  
CH08006AGADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280907/01/2024  
CH08006AALBERTSONS LLCSAFEWAY PHARMACY #885 323 S BROADWAY
DENVERCO8020907/01/2022  
CH08006ABIOPLUS SPECIALTY PHARMACY LA, LLC2731 MANHATTAN BLVD STE B17
HARVEYLA7005807/01/2023 10/06/2024
CH08006AGCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2024  
CH08006AGCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2024  
CH08006AGCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2024  
CH08006AGCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2024  
CH08006AGCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2024  
CH08006AGCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2024  
CH08006AGCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2024  
CH08006AGCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813307/01/2024  
CH08006AGCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237407/01/2024  
CH08006AGCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2024  
CH08006AGCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2022  
CH08006ACVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2022  
CH08006AGCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2022  
CH08006AGCVS PHARMACY, INCCVS/PHARMACY # 10959 1900 18TH STREET, 1ST FLOOR
DENVERCO8020207/01/2022  
CH08006AGCVS PHARMACY, INC.CVS PHARMACY # 16929 4301 E VIRGINIA AVE
GLENDALECO8024607/01/2022  
CH08006AGCVS PHARMACY, INC.DBA CVS/PHARMACY #10804 750 16TH STREET
DENVERCO8020207/01/2022  
CH08006AGCVS PHARMACY, INC.CVS/PHARMACY # 10784 3770 SHERIDAN BLVD
DENVERCO8021207/01/2022  
CH08006AGCVS PHARMACY, INC.CVS PHARMACY # 17142 7930 NORTHFIELD BLVD
DENVERCO8023807/01/2022  
CH08006AGCVS PHARMACY, INC.CVS PHARMACY # 17302 1985 SHERIDAN BLVD
EDGEWATERCO8021407/01/2024  
CH08006AGCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2024  
CH08006ACYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/01/2022  
CH08006AGDENVER HEALTH CENTRAL FILL PHARMACYDENVER HEALTH AND HOSPITAL AUTHORITY 500 QUIVAS ST
STE A
DENVERCO8020407/01/2019 10/28/2020
CH08006AGDENVER HEALTH MEDICAL CENTERHOSPITAL PHARMACY 790 DELAWARE ST
DENVERCO8020407/01/2019 10/28/2020
CH08006AGDENVER HEALTH OUTPATIENT MEDICAL CENTERDENVER HEALTH AND HOSPITAL AUTHORITY 660 N. BANNOCK ST
DENVERCO8020407/01/2019 10/28/2020
CH08006AGDENVER HEALTH PRIMARY CARE PHARMACYDENVER HEALTH AND HOSPITAL AUTHORITY 301 W 6TH AVE
DENVERCO8020407/01/2019 10/28/2020
CH08006AGEASTSIDE NEIGHBORHOOD HEALTH CENTER501 28TH ST
DENVERCO8020507/01/2019 10/28/2020
CH08006AESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111212/21/2022  
CH08006AEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313412/21/2022  
CH08006AEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607512/21/2022  
CH08006AEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801612/21/2022  
CH08006AKING SOOPERS PHARMACYDIV DILLON CO 1155 E 9TH AVE
DENVERCO8021807/01/2022  
CH08006AKING SOOPERS PHARMACYDIV DILLON COMPANIES INC 6470 E HAMPDEN AVE
DENVERCO8022207/01/2022  
CH08006AKING SOOPERS PHARMACYDIV DILLON COMPANIES INC 5125 WEST FLORIDA
DENVERCO8021907/01/2022  
CH08006AKING SOOPERS PHARMACY3100 SOUTH SHERIDAN BLVD. #2
DENVERCO8022707/01/2023  
CH08006AKING SOOPERS PHARMACY #11331 NORTH SPEER BLVD
DENVERCO8020407/01/2022  
CH08006AKING SOOPERS PHARMACY #1277984 W. ALAMEDA
LAKEWOODCO8022607/01/2022  
CH08006AKING SOOPERS PHARMACY #131100 LITTLETON BLVD
LITTLETONCO8012007/01/2023  
CH08006AKING SOOPERS PHARMACY #14655 PEORIA ST
AURORACO8001107/01/2023  
CH08006AKING SOOPERS PHARMACY #341575 W 84TH AVE
FEDERAL HEIGHTSCO8022107/01/2022  
CH08006AKING SOOPERS PHARMACY #562727 W EVANS AVE
DENVERCO8021907/01/2022  
CH08006AKING SOOPERS PHARMACY #575301 W 38TH AVE
WHEAT RIDGECO80212-705807/01/2022  
CH08006AKING SOOPERS PHARMACY #901725 SHERIDAN BLVD.
EDGEWATERCO8021407/01/2022  
CH08006AKING SOOPERS PHARMACY #932810 QUEBEC ST
DENVERCO8020707/01/2022  
CH08006AGLA CASA-QUIGG NEWTON HEALTH CENTER PHARMLA CASA-QUIGG NEWTON HEALTH CENTER PHARM DENVER HEALTH
4545 NAVAJO ST
DENVERCO8021107/01/2019 10/28/2020
CH08006AGLOWRY FAMILY HEALTH CENTER PHARMACY1001 YOSEMITE ST
DENVERCO8023007/01/2019 10/28/2020
CH08006AGMONTBELLO FAMILY HEALTH CENTER PHARMACYDENVER HEALTH 12600 E. ALBROOK DR.
DENVERCO8023907/01/2019 10/28/2020
CH08006AOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502907/01/2022  
CH08006AOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/01/2022  
CH08006AOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/01/2022  
CH08006AOPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970507/01/2022  
CH08006AOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/01/2022  
CH08006AOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660807/01/2022 01/01/2023
CH08006APRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDOFL32819-999207/01/2022 01/24/2023
CH08006AGPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2024  
CH08006AGPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2024  
CH08006AGPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2024  
CH08006ASAFEWAY INCSAFEWAY PHARMACY #2246 757 E 20TH AVE
DENVERCO80205-327807/01/2022  
CH08006ASAFEWAY INCSAFEWAY PHARMACY #1614 560 CORONA STREET
DENVERCO8021807/01/2022  
CH08006ASAFEWAY INCSAFEWAY PHARMACY #1248 2660 FEDERAL BLVD
DENVERCO8021107/01/2022  
CH08006ASAFEWAY INCSAFEWAY PHARMACY #2714 6220 EAST 14TH AVENUE
DENVERCO8022007/01/2022  
CH08006ATHE KROGER CO., KS 1131220 S. LIPAN STREET
DENVERCO8022307/01/2022  
CH08006AGWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738609/07/2022  
CH08006AGWAL-MART PHARMACY 10-12319901 GRANT ST.
THORNTONCO8022909/07/2022  
CH08006AGWAL-MART PHARMACY 10-13087700 WEST QUINCY AVE
LITTLETONCO8012309/07/2022  
CH08006AGWAL-MART PHARMACY 10-149214000 EAST EXPOSITION AVENUE
AURORACO8001209/07/2022  
CH08006AGWAL-MART PHARMACY 10-16895650 SOUTH CHAMBERS RD
AURORACO8001509/07/2022  
CH08006AGWAL-MART PHARMACY 10-21257455 WEST COLFAX AVE
LAKEWOODCO8021409/07/2022  
CH08006AGWAL-MART PHARMACY 10-31275141 CHAMBERS RD
DENVERCO8023909/07/2022  
CH08006AGWAL-MART PHARMACY 10-331310900 EAST BRIARWOOD AVENUE
CENTENNIALCO8011109/07/2022  
CH08006AGWAL-MART PHARMACY 10-35337800 EAST SMITH ROAD
DENVERCO8020709/07/2022  
CH08006AGWAL-MART PHARMACY 10-35669400 EAST HAMPDEN AVENUE
AURORACO8023109/07/2022  
CH08006AGWAL-MART PHARMACY 10-38247155 SHERIDAN BLVD
WESTMINISTERCO8000309/07/2022  
CH08006AGWAL-MART PHARMACY 10-4284440 WADSWORTH BLVD
LAKEWOODCO8022609/07/2022  
CH08006AGWAL-MART PHARMACY 10-53343301 NORTH TOWER ROAD
AURORACO8001109/07/2022  
CH08006AGWAL-MART PHARMACY 10-59575957 WEST 44TH AVE
DENVERCO80212-741009/07/2022  
CH08006AGWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283709/07/2022  
CH08006AWALGREEN CODBA WALGREENS SPECIALTY PHARMACY #11255 4545 E 9TH AVE STE 100
DENVERCO8022007/01/2022  
CH08006AWALGREEN CODBA: WALGREENS #10739 15310 E COLFAX AVE
AURORACO8001107/01/2022  
CH08006AWALGREEN CODBA: WALGREENS #12366 360 S COLORADO BLVD
GLENDALECO8024607/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 03266 6395 SHERIDAN BLVD.
ARVADACO8000307/01/2022 02/20/2025
CH08006AWALGREEN CO.DBA: WALGREENS # 03298 3080 S BROADWAY
ENGLEWOODCO8011307/01/2022 09/30/2024
CH08006AWALGREEN CO.DBA: WALGREENS # 07253 18550 GREEN VALLEY RANCH BLVD
DENVERCO80249-666207/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS #10116 3067 S SHERIDAN BLVD
DENVERCO80227-415007/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS #15434 3555 COLORADO BLVD
DENVERCO8020507/01/2022 02/26/2025
CH08006AWALGREEN CO.DBA: WALGREENS # 03500 950 S QUEBEC ST
DENVERCO8024707/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 04667 1601 W. 84TH AVE.
FEDERAL HEIGHTSCO80260-500107/01/2022 02/06/2025
CH08006AWALGREEN CO.DBA: WALGREENS #13968 7551 W. ALAMEDA AVE
LAKEWOODCO8022607/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 04301 2975 FEDERAL
DENVERCO8021107/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 01769 2000 E COLFAX
DENVERCO8020607/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 03867 6200 E COLFAX
DENVERCO8022007/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 07581 7311 E 29TH DRIVE
DENVERCO8023807/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 03190 1111 S COLORADO BLVD
DENVERCO80246-290107/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 06986 10601 E ALAMEDA AVE
AURORACO8001207/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 09657 5151 W COLFAX AVE
DENVERCO80204-101607/01/2022 11/12/2024
CH08006AWALGREEN CO.DBA: WALGREENS #10935 300 S FEDERAL BLVD
DENVERCO8021907/01/2022 11/14/2024
CH08006AWALGREEN CO.DBA: WALGREENS # 00356 801 16TH STREET
DENVERCO8020207/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 02843 120 N BROADWAY
DENVERCO8020307/01/2022  
CH08006AWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #12805 499 E HAMPDEN AVE STE 150
ENGLEWOODCO8011307/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 03655 10501 E. COLFAX AVE.
AURORACO8001007/01/2022 11/13/2023
CH08006AWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #13100 1601 E 19TH AVE STE 4650
DENVERCO8021807/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 11101 7190 E HAMPDEN AVE
DENVERCO8022407/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 04366 4401 WADSWORTH BLVD.
WHEAT RIDGECO8003307/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 06827 1505 S FEDERAL BLVD
DENVERCO80219-472207/01/2022 02/29/2024
CH08006AWALGREEN CO.DBA: WALGREENS # 09567 1235 E EVANS AVE
DENVERCO80210-453107/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 06552 7211 FEDERAL BLVD
WESTMINSTERCO8003007/01/2022  
CH08006AWALGREEN CO.DBA: WALGREENS # 10070 6360 E EVANS AVE
DENVERCO8022207/01/2022 02/27/2025
CH08006AWALGREEN CO.DBA: WALGREENS # 04307 12051 E MISSISSIPPI AVE
AURORACO8001207/01/2022 02/19/2025
CH08006AWalgreens #21397Walgreens Central Fill #21397 5675 Pecos St.
Suite 100
DenverCO80221-665510/01/2022  
CH08006AWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/01/2022  
CH08006AWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/01/2022  
CH08006AWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/01/2022  
CH08006AGWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275602/06/2023  
CH08006AGWALMART PHARMACY 10-56762770 W EVANS AVENUE
DENVERCO8021909/07/2022  
CH08006AGWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616804/01/2024  
CH08006AGWESTSIDE NEIGHBORHOODHEALTH CENTER 1100 FEDERAL BLVD
WESTSIDE HEALTH CENTER
DENVERCO80204-321907/01/2019 10/28/2020
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated4/1/2025 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateRecertification 12/31/2021 12:00:00 AM2/23/2025 12:41 PM
DetailsStateUpdateRecertificationActiveTo Be Terminated2/23/2025 12:41 PM
TerminationsTermination CommentsUpdateRecertification The site number H80-003213 was deleted from our scope when we separated the clinics on our main campus (777 Bannock Street), (OB/GYN “Women’s Care” and the Pediatric Urgent Care). It was removed in 2021 per the request from our HRSA Operational Site Visit auditors. Each clinic has a new site number on FORM 5B.2/23/2025 12:41 PM
TerminationsTermination DateUpdateRecertification 4/1/2025 12:00:00 AM2/23/2025 12:41 PM
TerminationsTermination Effective DateUpdateRecertification 12/31/2021 12:00:00 AM2/23/2025 12:41 PM
TerminationsTermination ReasonUpdateRecertification Other2/23/2025 12:41 PM
ContactsAuthorizing OfficialUpdateGroup Change RequestHambidge, Simon Chief Ambulatory Care Services Denver Health 3036025120Hanratty, Rebecca Chief Ambulatory Officer Denver Health and Hospital Authority 303602639712/4/2024 8:09 AM
AddressesShipping AddressDeleteChange RequestDenver Health Pharmacy at Denver Public Health 605 Bannock St Denver, CO 80204 11/20/2024 10:43 AM
DetailsLast Recertification DateUpdateRecertification1/31/2023 11:58:29 AM1/30/2024 10:28:34 AM1/30/2024 10:28 AM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 900017855511/13/2023 3:15 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 900018010811/13/2023 3:15 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 1735238011/13/2023 3:15 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 1190424111/13/2023 3:15 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 3040687111/13/2023 3:15 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 0563882011/13/2023 3:15 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingMedicaid: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
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Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 195269949811/13/2023 3:15 PM
Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 130604250211/13/2023 3:15 PM
Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 121598798711/13/2023 3:15 PM
Medicaid BillingNPI: StateInsertGroup Change Request CO11/13/2023 3:15 PM
DetailsLast Recertification DateUpdateRecertification1/31/2022 6:35:05 PM1/31/2023 11:58:29 AM1/31/2023 11:58 AM
DetailsLast Recertification DateUpdateRecertification2/3/2021 6:43:29 AM1/31/2022 6:35:05 PM1/31/2022 6:35 PM
Medicaid BillingNPI: NumberInsertChange Request 10234649066/11/2021 11:05 AM
Medicaid BillingNPI: StateInsertChange Request CO6/11/2021 11:05 AM
AddressesShipping AddressInsertRecertification Central Fill Pharmacy 500 QUIVAS ST STE A Denver, CO 802042/3/2021 6:43 AM
AddressesShipping AddressInsertRecertification Denver Health Pharmacy at Bernard F. Gibson Eastside Family Health Center 501 28th St. Denver, CO 802052/3/2021 6:43 AM
AddressesShipping AddressInsertRecertification Denver Health Pharmacy at La Casa/Quigg Newton Family Health Center 4545 Navajo St. Denver, CO 802112/3/2021 6:43 AM
AddressesShipping AddressInsertRecertification Denver Health Pharmacy at Lowry Family Health Center 1001 Yosemite St Denver, CO 802302/3/2021 6:43 AM
AddressesShipping AddressInsertRecertification Denver Health Pharmacy at Montbello Family Health Center 12600 E. Albrook Dr Denver, CO 802392/3/2021 6:43 AM
AddressesShipping AddressInsertRecertification Denver Health Pharmacy at Denver Public Health 605 Bannock St Denver, CO 802042/3/2021 6:43 AM
AddressesShipping AddressInsertRecertification Denver Health Pharmacy at Federico F. Pena Southwest Family Health Center 1339 S. Federal Blvd. Denver, CO 802192/3/2021 6:43 AM
AddressesShipping AddressInsertRecertification Denver Health Pharmacy at Webb Center for Primary Care 301 W. 6th Ave. Denver, CO 802042/3/2021 6:43 AM
AddressesShipping AddressInsertRecertification Denver Health Pharmacy at Sam Sandos Westside Family Health Center 1100 Federal Blvd. Denver, CO 802042/3/2021 6:43 AM
AddressesShipping AddressInsertRecertification Denver Health Outpatient Medical Center 660 N Bannock St. Denver, CO 802042/3/2021 6:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 777350722/3/2021 6:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 289708452/3/2021 6:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 030023342/3/2021 6:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 032950032/3/2021 6:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 034984412/3/2021 6:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 030026312/3/2021 6:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 039485022/3/2021 6:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 070323822/3/2021 6:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 283585622/3/2021 6:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/3/2021 6:43 AM
Medicaid BillingMedicaid: NumberInsertRecertification 394927882/3/2021 6:43 AM
Medicaid BillingMedicaid: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: StateUpdateRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: StateUpdateRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: StateUpdateRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: NumberInsertRecertification 12554707952/3/2021 6:43 AM
Medicaid BillingNPI: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: NumberInsertRecertification 10332549252/3/2021 6:43 AM
Medicaid BillingNPI: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: NumberInsertRecertification 19826274932/3/2021 6:43 AM
Medicaid BillingNPI: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: NumberInsertRecertification 12856575282/3/2021 6:43 AM
Medicaid BillingNPI: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: NumberInsertRecertification 13169605862/3/2021 6:43 AM
Medicaid BillingNPI: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: NumberInsertRecertification 17200021812/3/2021 6:43 AM
Medicaid BillingNPI: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: NumberInsertRecertification 10836373262/3/2021 6:43 AM
Medicaid BillingNPI: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: NumberInsertRecertification 11748191972/3/2021 6:43 AM
Medicaid BillingNPI: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: NumberInsertRecertification 18113280322/3/2021 6:43 AM
Medicaid BillingNPI: StateInsertRecertification CO2/3/2021 6:43 AM
Medicaid BillingNPI: NumberInsertRecertification 11648839552/3/2021 6:43 AM
Medicaid BillingNPI: StateInsertRecertification CO2/3/2021 6:43 AM
DetailsLast Recertification DateUpdateRecertification1/29/2020 7:00:47 AM2/3/2021 6:43:29 AM2/3/2021 6:43 AM
AddressesShipping AddressInsertRecertification Denver Health Acute Pharmacy 790 Delaware St Denver, CO 802041/29/2020 7:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False1/29/2020 7:00 AM
Medicaid BillingMedicaid: NumberInsertRecertification 311723261/29/2020 7:00 AM
Medicaid BillingMedicaid: StateInsertRecertification CO1/29/2020 7:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False1/29/2020 7:00 AM
Medicaid BillingMedicaid: NumberInsertRecertification 040192201/29/2020 7:00 AM
Medicaid BillingMedicaid: StateInsertRecertification CO1/29/2020 7:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False1/29/2020 7:00 AM
Medicaid BillingMedicaid: NumberInsertRecertification 050110021/29/2020 7:00 AM
Medicaid BillingMedicaid: StateInsertRecertification CO1/29/2020 7:00 AM
Medicaid BillingMedicaid: NumberDeleteRecertification05900139 (CO) 1/29/2020 7:00 AM
Medicaid BillingNPI: NumberInsertRecertification 18119195661/29/2020 7:00 AM
Medicaid BillingNPI: NumberInsertRecertification 14777461051/29/2020 7:00 AM
Medicaid BillingNPI: NumberInsertRecertification 16896246861/29/2020 7:00 AM
Medicaid BillingNPI: NumberDeleteRecertification1922049014 ( ) 1/29/2020 7:00 AM
DetailsLast Recertification DateUpdateRecertification2/22/2019 4:54:59 PM1/29/2020 7:00:47 AM1/29/2020 7:00 AM
DetailsEntity NameUpdateRecertificationDENVER HEALTH AND HOSPITALS AUTHORITYDENVER HEALTH AND HOSPITAL AUTHORITY1/29/2020 7:00 AM
DetailsLast Recertification DateUpdateRecertification2/11/2018 4:28:20 PM2/22/2019 4:54:59 PM2/22/2019 4:54 PM
ContactsPrimary ContactUpdateChange RequestKurtz, Andrew Director of Ambulatory Pharmacy Denver Health and Hospital Authority 3036028535Seoldo-Hinman, Nathalie Admin Director of Pharmacy Services Denver Health and Hospital Authority 30360292111/22/2019 8:39 PM
DetailsIs Authorizing Official EHB DataUpdateChange RequestFalse 1/22/2019 8:39 PM
DetailsLast Recertification DateUpdateRecertification2/13/2017 12:00:00 AM2/11/2018 4:28:20 PM2/11/2018 4:28 PM
ContactsAuthorizing OfficialUpdate Hambidge, Simon Chief Ambulatory Care Services 3036025120Hambidge, Simon Chief Ambulatory Care Services Denver Health 30360251201/9/2018 8:09 PM
ContactsSigned ByUpdate Hambidge, Simon Chief Ambulatory Care Services 3036025120Hambidge, Simon Chief Ambulatory Care Services Denver Health 30360251201/9/2018 8:09 PM
ContactsPrimary ContactUpdate Kurtz, Andrew Director of Ambulatory Pharmacy 3036028535Kurtz, Andrew Director of Ambulatory Pharmacy Denver Health and Hospital Authority 30360285359/18/2017 5:43 PM
ContactsPrimary ContactInsert  Kurtz, Andrew Director of Ambulatory Pharmacy 30360285357/27/2017 10:50 AM
ContactsAuthorizing OfficialInsert  Hambidge, Simon Chief Ambulatory Care Services 30360251204/26/2017 8:08 PM
ContactsSigned ByInsert  Hambidge, Simon Chief Ambulatory Care Services 30360251204/26/2017 8:08 PM
AddressesMain AddressInsert   777 BANNOCK ST DENVER, CO 80204-45072/13/2017 11:58 AM
DetailsLast Recertification DateUpdate 2/16/2016 12:00:00 AM2/13/2017 12:00:00 AM2/13/2017 11:58 AM
DetailsLast Recertification DateUpdate  2/16/2016 12:00:00 AM2/20/2016 5:06 PM
DatesParticipating Approval DateUpdate  10/23/2015 12:00:00 AM10/23/2015 1:31 PM
DetailsStateUpdate PendingActive10/23/2015 1:31 PM
DatesStart DateUpdate  1/1/2016 12:00:00 AM10/23/2015 1:31 PM
Details340B IDUpdate ONLINE_REG_54152CH08006AD10/20/2015 2:54 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_5415210/1/2015 11:18 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/1/2015 11:18 AM
Medicaid BillingMedicaid: NumberInsert  0590013910/1/2015 11:18 AM
Medicaid BillingMedicaid: StateInsert  CO10/1/2015 11:18 AM
Medicaid BillingNPI: NumberInsert  192204901410/1/2015 11:18 AM
DetailsLast Recertification DateInsert   10/1/2015 11:18 AM
DetailsGrant NumberInsert  H80CS0021810/1/2015 11:18 AM
Details340B IDInsert  ONLINE_REG10/1/2015 11:18 AM
DetailsIs Authorizing Official EHB DataInsert  False10/1/2015 11:18 AM
DatesLast Date That 340B Drugs PurchasedInsert   10/1/2015 11:18 AM
DetailsMedicare Provider NumberInsert   10/1/2015 11:18 AM
DetailsEntity NameInsert  DENVER HEALTH AND HOSPITALS AUTHORITY10/1/2015 11:18 AM
DetailsProgram CodeInsert  CH10/1/2015 11:18 AM
DetailsEntity SubnameInsert  DENVER HEALTH MEDICAL CAMPUS10/1/2015 11:18 AM
DatesParticipating Approval DateInsert   10/1/2015 11:18 AM
DetailsStateInsert  Pending10/1/2015 11:18 AM
DatesRegistration DateInsert  10/1/2015 12:00:00 AM10/1/2015 11:18 AM
DatesSigned By DateInsert  10/1/2015 12:00:00 AM10/1/2015 11:18 AM
DatesStart DateInsert   10/1/2015 11:18 AM
TerminationsTermination CommentsInsert   10/1/2015 11:18 AM
TerminationsTermination DateInsert   10/1/2015 11:18 AM
TerminationsTermination Effective DateInsert   10/1/2015 11:18 AM
TerminationsTermination ReasonInsert   10/1/2015 11:18 AM