| Details | Last Recertification Date | Update | Recertification | 2/13/2024 2:13:14 PM | 2/21/2025 12:34:39 PM | 2/21/2025 12:34 PM |
| Contacts | Primary Contact | Update | Recertification | Rivera, Yaritza
Chief Compliance Officer
Corporación de Servicios Médicos Primarios y Prevención de Hatillo
7878984190-416 | ROMAN ACEVEDO, JACKELINE
Compliance Officer
CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
7878984190-416 | 2/13/2024 2:13 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2023 9:11:14 AM | 2/13/2024 2:13:14 PM | 2/13/2024 2:13 PM |
| Details | Last Recertification Date | Update | Recertification | 3/1/2022 8:04:34 AM | 2/1/2023 9:11:14 AM | 2/1/2023 9:11 AM |
| Addresses | Shipping Address | Update | Change Request | Farmacia CSM Arecibo
450 Avenida Miramar
Arecibo, PR 00612 | Farmacia CSM Arecibo
Avenida Miramar PR 2 KM 77.1
Duhamel Commercial Building Local #8
Arecibo, PR 00612 | 1/10/2023 9:40 AM |
| Contacts | Primary Contact | Update | Change Request | Velez, Yaritza Rivera
Chief Compliance Officer
CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
7878984190-416 | Rivera, Yaritza
Chief Compliance Officer
Corporación de Servicios Médicos Primarios y Prevención de Hatillo
7878984190-416 | 1/10/2023 9:40 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Gonzalez, Ana E
Compliance Officer
CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
7878984190-358 | Velez, Yaritza Rivera
Chief Compliance Officer
CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
7878984190-416 | 1/3/2023 4:39 PM |
| Addresses | Shipping Address | Insert | Recertification | | Farmacia CSM Arecibo
450 Avenida Miramar
Arecibo, PR 00612 | 3/1/2022 8:04 AM |
| Addresses | Main Address | Update | Recertification |
50 Calle Cervantes
Arecibo, PR 00612-4520 |
450 Avenida Miramar
Arecibo, PR 00612 | 3/1/2022 8:04 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 3/1/2022 8:04 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 037632208 | 3/1/2022 8:04 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | PR | 3/1/2022 8:04 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | PR | 3/1/2022 8:04 AM |
| Details | Last Recertification Date | Update | Recertification | 3/10/2021 4:21:05 PM | 3/1/2022 8:04:34 AM | 3/1/2022 8:04 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Del Rio, Marisol Rodriguez
Chief Executive Officer
Farmacia San Miguel
7878984190 | Torres Mercado, Lorena
CEO
Corporacion de Servicios Medicos Primarios y Prevencion de Hatillo
7878984190-406 | 2/28/2022 9:55 AM |
| Details | Last Recertification Date | Update | Recertification | 2/18/2020 7:58:01 AM | 3/10/2021 4:21:05 PM | 3/10/2021 4:21 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Legarreta, Armando
Executive Director
CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
7878984190-222 | Del Rio, Marisol Rodriguez
Chief Executive Officer
Farmacia San Miguel
7878984190 | 3/8/2021 11:52 AM |
| Details | Last Recertification Date | Update | Recertification | 2/27/2019 1:01:42 PM | 2/18/2020 7:58:01 AM | 2/18/2020 7:58 AM |
| Details | Last Recertification Date | Update | Recertification | 3/6/2018 8:26:58 AM | 2/27/2019 1:01:42 PM | 2/27/2019 1:01 PM |
| Contacts | Primary Contact | Update | Recertification | Legarreta, Armando
Executive Director
CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
7878984190-222 | Gonzalez, Ana E
Compliance Officer
CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
7878984190-358 | 3/6/2018 8:26 AM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2017 12:00:00 AM | 3/6/2018 8:26:58 AM | 3/6/2018 8:26 AM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 3/6/2018 8:26 AM |
| Contacts | Authorizing Official | Update | | Legarreta, Armando
Executive Director
7878984190-222 | Legarreta, Armando
Executive Director
CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
7878984190-222 | 2/27/2018 10:36 AM |
| Contacts | Primary Contact | Update | | Legarreta, Armando
Executive Director
7878984190-222 | Legarreta, Armando
Executive Director
CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
7878984190-222 | 2/27/2018 10:36 AM |
| Contacts | Signed By | Update | | Legarreta, Armando
Executive Director
7878984190-222 | Legarreta, Armando
Executive Director
CORPORACION DE SERVICIOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO
7878984190-222 | 2/27/2018 10:36 AM |
| Contacts | Authorizing Official | Insert | | | Legarreta, Armando
Executive Director
7878984190-222 | 7/19/2017 9:46 AM |
| Contacts | Primary Contact | Insert | | | Legarreta, Armando
Executive Director
7878984190-222 | 7/19/2017 9:46 AM |
| Contacts | Signed By | Insert | | | Legarreta, Armando
Executive Director
7878984190-222 | 7/19/2017 9:46 AM |
| Addresses | Main Address | Insert | | |
50 Calle Cervantes
Arecibo, PR 00612-4520 | 2/17/2017 1:37 PM |
| Details | Last Recertification Date | Update | | | 2/17/2017 12:00:00 AM | 2/17/2017 1:37 PM |
| Addresses | Billing Address | Insert | | | Corporacion de Servicios Medicos Primarios y Prevencion de Hatillo
PO BOX 907
Hatillo, PR 00659-1843 | 1/7/2016 3:46 PM |
| Dates | Participating Approval Date | Update | | | 1/7/2016 12:00:00 AM | 1/7/2016 3:45 PM |
| Details | State | Update | | Pending | Active | 1/7/2016 3:45 PM |
| Dates | Start Date | Update | | | 4/1/2016 12:00:00 AM | 1/7/2016 3:45 PM |
| Details | 340B ID | Update | | ONLINE_REG_56583 | CH02126A | 1/6/2016 8:57 AM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_56583 | 1/5/2016 2:49 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1306877279 | 1/5/2016 2:49 PM |
| Details | Last Recertification Date | Insert | | | | 1/5/2016 2:49 PM |
| Details | Grant Number | Insert | | | H80CS00334 | 1/5/2016 2:49 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 1/5/2016 2:49 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 1/5/2016 2:49 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/5/2016 2:49 PM |
| Details | Medicare Provider Number | Insert | | | | 1/5/2016 2:49 PM |
| Details | Entity Name | Insert | | | CORPORACION DE SERVICOS MEDICOS PRIMARIOS Y PREVENCION DE HATILLO | 1/5/2016 2:49 PM |
| Details | Program Code | Insert | | | CH | 1/5/2016 2:49 PM |
| Details | Entity Subname | Insert | | | CSM Arecibo Satellite Clinic | 1/5/2016 2:49 PM |
| Dates | Participating Approval Date | Insert | | | | 1/5/2016 2:49 PM |
| Details | State | Insert | | | Pending | 1/5/2016 2:49 PM |
| Dates | Registration Date | Insert | | | 1/5/2016 12:00:00 AM | 1/5/2016 2:49 PM |
| Dates | Signed By Date | Insert | | | 1/5/2016 12:00:00 AM | 1/5/2016 2:49 PM |
| Dates | Start Date | Insert | | | | 1/5/2016 2:49 PM |
| Terminations | Termination Comments | Insert | | | | 1/5/2016 2:49 PM |
| Terminations | Termination Date | Insert | | | | 1/5/2016 2:49 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/5/2016 2:49 PM |
| Terminations | Termination Reason | Insert | | | | 1/5/2016 2:49 PM |