Covered Entity Details

CH06301S CLINICA DE FAMILIA INC, LA (Terminated) - information as of 6/9/2025 11:05:41 PM

Main Details

Name

CLINICA DE FAMILIA INC, LA

Subdivision Name

Anthony Mental Health

Type

HRSA-Funded Health Center

Site ID

BPS-H80-017161

340B ID

CH06301S

Grant Number

H80CS00316

Additional Details

Current Program Status

Terminated

Registration Date

1/14/2016

Participating Start Date

4/1/2016

Participating Approval Date

2/11/2016

Last Recertification Date

2/28/2018

Termination Date
Termination Reason

4/1/2019
Site closure

Contacts

Authorizing Official

La Clinica de Familia, Inc.
Virgil Medina, CEO
(575) 526-1105

Primary Contact

La Clinica de Familia, Inc.
Olivia Martinez, Accounting Manager
(575) 526-1105

Addresses

Street Address

880 Anthony Drive Suite A
Anthony, NM 88021-9346

Billing Address

La Clinica de Familia, Inc.
385 Calle de Alegra, Bldg. A
Las Cruces, NM 88005-3423

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
NM	61386561

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
CH063010	Active	BPS-H80-009517	LA CLINICA DE FAMILIA, INC.	LCDF Administration Office	385 Calle de Alegra BLDG A	Las Cruces	NM
CH06301A	Active	BPS-H80-001789	LA CLINICA DE FAMILIA, INC	ANTHONY MEDICAL AND DENTAL CLINIC	855 ANTHONY DRIVE,	ANTHONY	NM
CH06301AA	Active	BPS-H80-019119	LA CLINICA DE FAMILIA, INC.	Gadsden High SBHC	6301 Highway 28	Anthony	NM
CH06301AB	Terminated	BPS-H80-017633	CLINICA DE FAMILIA INC, LA	Anthony Psychosocial Rehabilitation	880 Anthony Drive, Suite 12	Anthony	NM
CH06301AC	Active	BPS-H80-019166	LA CLINICA DE FAMILIA, INC.	Chaparral High SBHC	800 S County Line Dr	Chaparral	NM
CH06301AD	Active	BPS-H80-019517	LA CLINICA DE FAMILIA INC,	Central Medical Complex	575 S. Alameda	Las Cruces	NM
CH06301AE	Active	BPS-H80-021322	CLINICA DE FAMILIA INC, LA	Anthony Mental Health	826 Anthony Dr	Anthony	NM
CH06301AF	Active	BPS-H80-009376	CLINICA DE FAMILIA INC, LA	Chaparral Annex	510 E. Lisa Drive BLDG 2	Chaparral	NM
CH06301AG	Active	BPS-H80-029805	CLINICA DE FAMILIA INC, LA	Desert Pride SBHC	100 Shrode Rd	Anthony	NM
CH06301AH	Active	BPS-H80-029959	LA CLINICA DE FAMILIA, INC.	Sunland Park Building B	2625 Mcnutt Road BLDG B	Sunland Park	NM
CH06301AJ	Active	BPS-H80-032332	CLINICA DE FAMILIA INC, LA	La Clinica de Familia's Community Mental Health Clinic	760 N Motel Blvd STE A-C	Las Cruces	NM
CH06301AK	Active	BPS-H80-036678	LA CLINICA DE FAMILIA INC	Picacho Middle School-Based Health Center	1040 N. Motel Blvd	Las Cruces	NM
CH06301AL	Active	BPS-H80-036677	LA CLINICA DE FAMILIA INC	Lynn Middle School School-Based Health Center	950 S Walnut Street	Las Cruces	NM
CH06301B	Active	BPS-H80-003443	LA CLINICA DE FAMILIA, INC	SUNLAND PARK MEDICAL AND DENTAL CLINIC	2625 MCNUTT RD	SUNLAND PARK	NM
CH06301C	Active	BPS-H80-010114	LA CLINICA DE FAMILIA, INC.	SAN MIGUEL MEDICAL & DENTAL CLINIC	18420 S. Highway 28	SAN MIGUEL	NM
CH06301G	Active	BPS-H80-005627	LA CLINICA DE FAMILIA, INC	EAST MESA MEDICAL AND DENTAL CLINIC	8600 BATAAN MEMORIAL E	LAS CRUCES	NM
CH06301H	Active	BPS-H80-009180	LA CLINICA DE FAMILIA, INC	Pediatrics	385 Calle de Alegra BLDG. B	LAS CRUCES	NM
CH06301K	Active	BPS-H80-004170	LA CLINICA DE FAMILIA, INC.	CHAPARRAL MEDICAL CLINIC	510 E LISA DR	CHAPARRAL	NM
CH06301L	Active	BPS-H80-002079	LA CLINICA DE FAMILIA, INC.	SANTA TERESA SCHOOL- BASED HEALTH CENTER	100 AIRPORT RD	SANTA TERESA	NM
CH06301M	Terminated	BPS-H80-001789	LA CLINICA DE FAMILIA, INC	ANTHONY DENTAL CLINIC	855 Anthony Drive	Anthony	NM
CH06301N	Terminated	BPS-H80-005627	LA CLINICA DE FAMILIA, INC	EAST MESA DENTAL CLINIC	8600 BATAAN MEMORIAL E	LAS CRUCES	NM
CH06301P	Active	BPS-H80-010100	LA CLINICA DE FAMILIA, INC.	LAS CRUCES WOMEN'S HEALTH 2	385 Calle de Alegra Bldg C	Las Cruces	NM
CH06301Q	Terminated	BPS-H80-003443	LA CLINICA DE FAMILIA, INC	SUNLAND PARK DENTAL CLINIC	2625 MCNUTT RD	SUNLAND PARK	NM
CH06301R	Active	BPS-H80-010901	LA CLINICA DE FAMILIA, INC.	Chaparral Dental Clinic	510 E. Lisa Drive BLDG 3	Chaparral	NM
CH06301S	Terminated	BPS-H80-017161	CLINICA DE FAMILIA INC, LA	Anthony Mental Health	880 Anthony Drive Suite A	Anthony	NM
CH06301T	Active	BPS-H80-031402	LA CLINICA DE FAMILIA, INC.	Adult Behavioral Health	535 S Miranda St	Las Cruces	NM
CH06301U	Active	BPS-H80-013424	CLINICA DE FAMILIA INC, LA	Centennial School-Based Health Center	1950 S. Sonoma Ranch Blvd	Las Cruces	NM
CH06301V	Terminated	BPS-H80-015399	CLINICA DE FAMILIA INC, LA	LCDF First Step	390 CALLE DE ALEGRA	LAS CRUCES	NM
CH06301W	Active	BPS-H80-017549	CLINICA DE FAMILIA INC, LA	Rio Grande Preparatory Institute	2355 Avenida de Mesilla	Mesillia	NM
CH06301X	Terminated	BPS-H80-017164	CLINICA DE FAMILIA INC, LA	Main Street Psychosocial Rehabilitation	125 S. Main Street	Las Cruces	NM
CH06301Y	Terminated	BPS-H80-016955	CLINICA DE FAMILIA INC, LA	Griggs Assertive Community Treatment	105 W Griggs Ave.	Las Cruces	NM
CH06301Z	Terminated	BPS-H80-017162	CLINICA DE FAMILIA INC, LA	Children's Mental Health	118 S. Main St	Las Cruces	NM

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH06301C	CVS PHARMACY, INC.	DBA CVS/PHARMACY #7373	3011 N. MAIN ST.	LAS CRUCES	NM	88001	07/01/2017
CH06301C	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 10149	940 N. MAIN ST.	LAS CRUCES	NM	88001	07/01/2017
CH063010	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11100	8041 N. MESA STREET STE A	EL PASO	TX	79932	07/01/2022
CH063010	CVS PHARMACY, INC.	DBA CVS/PHARMACY #11020	680 E. REDD RD.	EL PASO	TX	79912	07/01/2022
CH063010	CVS PHARMACY, INC.	DBA CVS/PHARMACY # 10149	940 N. MAIN ST.	LAS CRUCES	NM	88001	07/01/2022
CH063010	CVS PHARMACY, INC.	CVS PHARMACY # 16269	801 SUNLAND PARK DR	EL PASO	TX	79912	07/01/2022
CH063010	CVS PHARMACY, INC.	DBA CVS/PHARMACY #7373	3011 N. MAIN ST.	LAS CRUCES	NM	88001	07/01/2022
CH06301H	FAMILY PHARMACY		1205 S SOLANO	LAS CRUCES	NM	88001	03/13/2009	12/31/2016
CH063010	GENOA HEALTHCARE LLC	100 W GRIGGS AVE STE P1		LAS CRUCES	NM	88001	10/01/2024
CH06301C	K MART PHARMACY #3682		1900 BATAAN MEMORIAL E	LAS CRUCES	NM	88011-6011	07/01/2017	05/01/2017
CH063010	MESILLA VALLEY PHARMACY & CONSULTING	4119 WHITE SAGE ARC STE E		LAS CRUCES	NM	88011	07/01/2022	11/14/2024
CH063010	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/01/2024
CH063010	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/01/2024
CH06301C	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2018
CH06301C	WAL-MART PHARMACY 10-0500	4530 WOODROW BEAN TRANSMTN. DR		EL PASO	TX	79924	10/01/2020
CH06301C	WAL-MART PHARMACY 10-0806	571 S WALTON BLVD.		LAS CRUCES	NM	88001	04/01/2017
CH06301C	WAL-MART PHARMACY 10-1015	7555 N. MESA		EL PASO	TX	79912	04/01/2017
CH06301C	WAL-MART PHARMACY 10-4601	3331 RINCONADA BLVD		LAS CRUCES	NM	88011	04/01/2017
CH06301C	WAL-MART PHARMACY 10-5155	1550 S VALLEY DR		LAS CRUCES (SW)	NM	88005	04/01/2017
CH06301C	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2018
CH063010	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	10/01/2021
CH06301C	WALGREEN ARIZONA DRUG CO.	WALGREENS CENTRAL FILL #21372	120 N 83RD AVE STE 200	TOLLESON	AZ	85353	10/01/2021
CH06301C	WALGREEN CO.	DBA: WALGREENS # 03924	5900 N MESA ST	EL PASO	TX	79912	06/13/2012
CH06301C	WALGREEN CO.	DBA: WALGREENS # 04421	3100 N. MAIN ST.	LAS CRUCES	NM	88001	06/13/2012
CH06301C	WALGREEN CO.	DBA: WALGREENS # 06543	10780 KENWORTHY	EL PASO	TX	79924	06/13/2012
CH06301C	WALGREEN CO.	DBA: WALGREENS # 07107	2300 E LOHMAN AVE	LAS CRUCES	NM	88001-8492	06/13/2012
CH06301C	WALGREEN CO.	DBA: WALGREENS # 09173	8050 N MESA STREET	EL PASO	TX	79932-1645	06/13/2012
CH06301C	WALGREEN CO.	DBA: WALGREENS #11458	3990 E. LOHMAN AVE.	LAS CRUCES	NM	88011	06/13/2012
CH06301C	WALGREEN CO.	DBA: WALGREENS # 11960	1256 EL PASEO ROAD	LAS CRUCES	NM	88001	06/13/2012
CH06301C	WALGREEN CO.	DBA: WALGREENS #12376	1432 ANTONIO ST.	ANTHONY	TX	79821	06/13/2012
CH06301C	WALGREEN CO.	DBA: WALGREENS #12469	2700 W. PICACHO AVE.	LAS CRUCES	NM	88007	06/13/2012
CH06301C	WALGREEN CO.	DBA: WALGREENS # 05274	2800 N MESA	EL PASO	TX	79902	07/01/2013	03/27/2018
CH06301C	WALGREEN CO.	DBA: WALGREENS #13927	3375 RINCONADA BLVD.	LAS CRUCES	NM	88011	07/01/2015
CH06301C	WALGREEN CO.	DBA: WALGREENS #15371	302 S OREGON ST	EL PASO	TX	79901	07/01/2015
CH06301C	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21172	2701 N MESA ST STE 100A	EL PASO	TX	79902	04/01/2024
CH06301C	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/01/2013
CH06301C	WALMART PHARMACY 10-4105	101 E REDD ROAD		EL PASO	TX	79932	10/01/2020
CH06301C	WALMART PHARMACY 10-5717	7831 PASEO DEL NORTE		EL PASO	TX	79912	10/01/2020
CH06301C	WALMART PHARMACY 10-6587	10840 MARTIN LUTHER KING JR.BOULEVARD		EL PASO	TX	79934	10/01/2020
CH06301C	WALMART PHARMACY 10-7229	1110 SUNLAND PARK DRIVE		EL PASO	TX	79922	10/01/2020
CH06301AD	ZIA PHARMACY	ZIA PHARMACY	2820 BROADBENT PKWY NE STE C	ALBUQUERQUE	NM	87107-1621	10/01/2018	08/31/2022
CH06301AD	ZIA PHARMACY	575 S ALAMEDA BLVD STE 102		LAS CRUCES	NM	88005-2818	04/01/2019	08/31/2022
CH063010	ZIA PHARMACY	575 S ALAMEDA BLVD STE 102		LAS CRUCES	NM	88005-2818	04/01/2019	08/31/2022
CH063010	ZIA PHARMACY	ZIA PHARMACY	2820 BROADBENT PKWY NE STE C	ALBUQUERQUE	NM	87107-1621	04/01/2019	08/31/2022

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Martinez, Olivia Senior Accountant La Clinica de Familia, Inc. 5755261105	Martinez, Olivia Accounting Manager La Clinica de Familia, Inc. 5755261105	2/20/2020 2:47 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		12/4/2017 12:00:00 AM	2/19/2019 1:36 PM
Details	State	Update	Recertification	Active	To Be Terminated	2/19/2019 1:36 PM
Terminations	Termination Comments	Update	Recertification		Move to a different location already added to the OPAIS.	2/19/2019 1:36 PM
Terminations	Termination Date	Update	Recertification		4/1/2019 12:00:00 AM	2/19/2019 1:36 PM
Terminations	Termination Effective Date	Update	Recertification		7/1/2018 12:00:00 AM	2/19/2019 1:36 PM
Terminations	Termination Reason	Update	Recertification		Site closure	2/19/2019 1:36 PM
Contacts	Primary Contact	Update	Recertification	MCKEEN, EILEEN CFO La Clinica de Familia, Inc. 5755261105-2414	Martinez, Olivia Senior Accountant La Clinica de Familia, Inc. 5755261105	2/28/2018 6:14 PM
Details	Last Recertification Date	Update	Recertification	2/20/2017 12:00:00 AM	2/28/2018 6:14:13 PM	2/28/2018 6:14 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/28/2018 6:14 PM
Contacts	Authorizing Official	Update	AO Change Request	Martinez de Gonzales, Suzan CEO 5755261105	Medina, Virgil CEO La Clinica de Familia, Inc. 5755261105	2/15/2018 8:18 AM
Contacts	Primary Contact	Update		MCKEEN, EILEEN CFO 5755261105-2414	MCKEEN, EILEEN CFO La Clinica de Familia, Inc. 5755261105-2414	10/10/2017 11:27 AM
Contacts	Primary Contact	Insert			MCKEEN, EILEEN CFO 5755261105-2414	7/3/2017 5:17 PM
Contacts	Authorizing Official	Insert			Martinez de Gonzales, Suzan CEO 5755261105	7/3/2017 5:17 PM
Contacts	Signed By	Insert			Martinez de Gonzales, Suzan CEO 5755261105	7/3/2017 5:17 PM
Addresses	Main Address	Insert			880 Anthony Drive Suite A Anthony, NM 88021-9346	2/20/2017 12:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/20/2017 12:55 PM
Medicaid Billing	Medicaid: Number	Insert			61386561	2/20/2017 12:55 PM
Medicaid Billing	Medicaid: State	Insert			NM	2/20/2017 12:55 PM
Details	Last Recertification Date	Update			2/20/2017 12:00:00 AM	2/20/2017 12:55 PM
Addresses	Billing Address	Insert			La Clinica de Familia, Inc. 385 Calle de Alegra, Bldg. A Las Cruces, NM 88005-3423	2/11/2016 9:40 AM
Dates	Participating Approval Date	Update			2/11/2016 12:00:00 AM	2/11/2016 9:40 AM
Details	State	Update		Pending	Active	2/11/2016 9:40 AM
Dates	Start Date	Update			4/1/2016 12:00:00 AM	2/11/2016 9:40 AM
Details	340B ID	Update		ONLINE_REG_58089	CH06301S	1/28/2016 11:36 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_58089	1/14/2016 7:03 PM
Details	Last Recertification Date	Insert				1/14/2016 7:03 PM
Details	Grant Number	Insert			H80CS00316	1/14/2016 7:03 PM
Details	340B ID	Insert			ONLINE_REG	1/14/2016 7:03 PM
Details	Is Authorizing Official EHB Data	Insert			False	1/14/2016 7:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/14/2016 7:03 PM
Details	Medicare Provider Number	Insert				1/14/2016 7:03 PM
Details	Entity Name	Insert			CLINICA DE FAMILIA INC, LA	1/14/2016 7:03 PM
Details	Program Code	Insert			CH	1/14/2016 7:03 PM
Details	Entity Subname	Insert			Anthony Mental Health	1/14/2016 7:03 PM
Dates	Participating Approval Date	Insert				1/14/2016 7:03 PM
Details	State	Insert			Pending	1/14/2016 7:03 PM
Dates	Registration Date	Insert			1/14/2016 12:00:00 AM	1/14/2016 7:03 PM
Dates	Signed By Date	Insert			1/14/2016 12:00:00 AM	1/14/2016 7:03 PM
Dates	Start Date	Insert				1/14/2016 7:03 PM
Terminations	Termination Comments	Insert				1/14/2016 7:03 PM
Terminations	Termination Date	Insert				1/14/2016 7:03 PM
Terminations	Termination Effective Date	Insert				1/14/2016 7:03 PM
Terminations	Termination Reason	Insert				1/14/2016 7:03 PM

340B Drug Pricing Program Database