340B Drug Pricing Program Database


CH09303E ADELANTE HEALTHCARE, INC. (Active) - information as of 6/21/2025 10:42:35 PM

Main Details
ADELANTE HEALTHCARE, INC.
Adelante Healthcare Surprise
HRSA-Funded Health Center
BPS-H80-011466
CH09303E
H80CS00140


Additional Details
Active
4/1/1999
4/1/1999
8/9/2005
2/12/2025

Contacts

Adelante Healthcare
Pedro Cons, CEO
(623) 583-3001 Ext: 011105

Adelante Healthcare
Amanda Christine Murray, 340b Program Manager
(602) 583-3001 Ext: 011312

Addresses

15351 W. Bell Road
Surprise, AZ 85374

ADELANTE HEALTHCARE
3033 N. Central Ave
PHOENIX, AZ 85012


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
3/9/12-Changed contact person (was Ed Young); 12/19/11 - Changed main address from 16560 NORTH DYSART ROAD SURPRISE, AZ 85378, AO info from AVEIN SAATY TAFOYA and contact info from Lisa Sawicke. 10/28/11 - Changed zip code from 85374. 5/13/11 UPDATED ENTITY NAME (WAS CLINICA ADELANTE, INC.); 2/28/11 ADDED BILL ADD03/09/2012
12/19/11 - Changed main address from 16560 NORTH DYSART ROAD SURPRISE, AZ 85378, AO info from AVEIN SAATY TAFOYA and contact info from Lisa Sawicke. 10/28/11 - Changed zip code from 85374. 5/13/11 UPDATED ENTITY NAME (WAS CLINICA ADELANTE, INC.); 2/28/11 ADDED BILL ADD12/19/2011
10/28/11 - Changed zip code from 85374. 5/13/11 UPDATED ENTITY NAME (WAS CLINICA ADELANTE, INC.); 2/28/11 ADDED BILL ADD10/28/2011
5/13/11 UPDATED ENTITY NAME (WAS CLINICA ADELANTE, INC.); 2/28/11 ADDED BILL ADD05/13/2011
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
AZ935809,156904,935737,156898,498274,007716,935684,518408,14501,334175,238264,935746,156901,935650,147958,162733,227624,935759,3111611801954441,1699434944,1386702942,1891454146,1275017915,1881217248,1891853446,1013476571,1770991291,1093227324,1205200565,1144419284,1598422453,1205994761,1235889270,1407132673,1003293465,1083772545,1528126133,1568249753,1356198832
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailFRY'S FOOD & DRUG #67413982 W. WADDELL ROAD
SURPRISEAZ8537906/16/201106/21/2011 09/29/201710/05/2017
Contract DetailQOL MEDS  15317 W BELL RD
STE 106
SURPRISEAZ8537410/03/201210/03/2012 09/29/201710/05/2017
Contract DetailWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06428 15385 N DYSART ROAD
EL MIRAGEAZ8533508/31/200608/31/2006 12/30/201601/05/2017
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH093030ActiveBPS-H80-024930ADELANTE HEALTHCARE, INC.Adelante Healthcare3033 N. Central Ave. PhoenixAZ
CH09303AActiveBPS-H80-003960ADELANTE HEALTHCARE, INC.Adelante Healthcare Gila Bend100 N. GILA AVENUE GILA BENDAZ
CH09303BActiveBPS-H80-012124ADELANTE HEALTHCARE, INC.Mesa Comprehensive HealthCare1705 W Main St MesaAZ
CH09303CActiveBPS-H80-002827ADELANTE HEALTHCARE, INC.Adelante Healthcare Buckeye306 E. MONROE BUCKEYEAZ
CH09303DActiveBPS-H80-007658ADELANTE HEALTHCARE, INC.Adelante Healthcare Wickenburg811 N. Tegner St Ste 113 WickenburgAZ
CH09303EActiveBPS-H80-011466ADELANTE HEALTHCARE, INC.Adelante Healthcare Surprise15351 W. Bell Road SurpriseAZ
CH09303GTerminatedBPS-H80-008622ADELANTE HEALTHCARE, INC.Adelante Healthcare Phoenix7725 N 43rd Ave STE 510 PhoenixAZ
CH09303HTerminatedBPS-H80-010238ADELANTE HEALTHCARE, INC.Adelante Healthcare Avondale Obstetrics and Gynecology3400 N Dysart Rd UNIT F-121/123 AvondaleAZ
CH09303JActiveBPS-H80-014117ADELANTE HEALTHCARE, INC.Adelante Healthcare Peoria15525 N 83RD AVE , Suite 104 PEORIAAZ
CH09303KActiveBPS-H80-015778ADELANTE HEALTHCARE, INC.Adelante Healthcare Surprise Same Day Clinic15317 West Bell Road, Suite 100 SurpriseAZ
CH09303LActiveBPS-H80-017508ADELANTE HEALTHCARE, INC.Adelante Healthcare Central Phoenix500 W THOMAS RD Ste 870 PHOENIXAZ
CH09303MActiveBPS-H80-011465Adelante Healthcare, Inc.Adelante Healthcare Surprise Dental Office15317 W. Bell Rd. STE 108 SurpriseAZ
CH09303NTerminatedBPS-H80-024930Adelante Healthcare, Inc.Adelante Healthcare3033 N Central Ave PhoenixAZ
CH09303PActiveBPS-H80-027068Adelante Healthcare, Inc.Adelante Healthcare Goodyear13471 W Cornerstone Blvd. GoodyearAZ
CH09303QActiveBPS-H80-032743Adelante Healthcare, Inc.Adelante Healthcare West Phoenix9610 N Metro Pkwy W PhoenixAZ
CH09303RActiveBPS-H80-033902Adelante Healthcare, Inc.Adelante Healthcare - MMU 113471 W Cornerstone Blvd GoodyearAZ
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH093030ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/01/2025  
CH093030ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/01/2025  
CH093030ALBERTSON'S LLCOSCO DRUG #977 14551 WEST GRAND AVENUE
SURPRISEAZ8537401/01/2019 01/07/2025
CH093030ALBERTSON'S LLCOSCO DRUG #980 1951 W BASELINE
MESAAZ8520207/01/2019 01/07/2025
CH093030ALBERTSON'S LLCOSCO DRUG #3941 5040 WEST CACTUS RD
GLENDALEAZ8530410/01/2019 01/07/2025
CH093030ALBERTSON'S LLCOSCO DRUG #940 750 E. GUADALUPE
TEMPEAZ8528310/01/2019 01/14/2020
CH093030ALBERTSON'S LLCOSCO DRUG #4 3130 W CAREFREE HWY
PHOENIXAZ8508610/01/2019 03/01/2021
CH093030ALBERTSON'S LLCOSCO DRUG #3926 12970 W INDIAN SCHOOL RD
LITCHFIELD PARKAZ8534010/01/2019 01/07/2025
CH093030ALBERTSON'S LLCOSCO DRUG #3989 2727 N. POWER ROAD
MESAAZ8521510/01/2019 03/01/2021
CH093030ALBERTSON'S LLCOSCO DRUG #2929 8454 S POWER RD
GILBERTAZ8529710/01/2019 01/14/2020
CH093030ALBERTSON'S LLCOSCO DRUG #1002 9243 E. BASELINE RD.
MESAAZ8520910/01/2019 03/01/2021
CH093030ALBERTSON'S LLCOSCO DRUG #1948 441 N. VAL VISTA DR
MESAAZ8521310/01/2019 03/01/2021
CH093030ALBERTSON'S LLCOSCO DRUG #958 325 S. POWER RD
MESAAZ8520610/01/2019 01/07/2025
CH093030ALBERTSON'S LLCOSCO DRUG #1221 2935 E RIGGS RD
CHANDLERAZ8524910/01/2019 03/01/2021
CH093030ALBERTSON'S LLCOSCO DRUG #2985 18411 N CAVE CREEK ROAD
PHOENIXAZ8503210/01/2019 03/01/2021
CH09303NAMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291104/01/2019 07/01/2019
CH093030AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291107/23/2019 01/04/2023
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09314 3440 WEST GLENDALE AVE
PHOENIXAZ8505101/01/2018  
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09218 1137 S. DOBSON RD #10
MESAAZ8520204/01/2018  
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09270 2033 W WICKENBURG WAY
WICKENBURGAZ8539007/01/2019  
CH093030ARIZONA CVS STORES, L.L.C.DBA CVS/PHARMACY # 8983 5125 W. OLIVE AVE
GLENDALEAZ8530207/01/2019  
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09347 1525 NORTH CENTRAL AVENUE
PHOENIXAZ8500407/01/2019 01/14/2025
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09256 3560 WEST PEORIA AVENUE
PHOENIXAZ8502907/01/2019  
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 08914 50 W. JEFFERSON ST., SUITE 140
PHOENIXAZ8500307/01/2019 03/01/2021
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09304 7434 W INDIAN SCHOOL RD
PHOENIXAZ8503307/01/2019 04/01/2019
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09225 2406 EAST THOMAS RD.
PHOENIXAZ8501607/01/2019 03/01/2021
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09213 305 E. BROWN RD.
MESAAZ8520107/01/2019  
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 03383 7550 SOUTH 19TH AVE.
PHOENIXAZ8504104/01/2020  
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09327 6021 S CENTRAL AVE
PHOENIXAZ8504207/01/2020 01/14/2025
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09297 6002 NORTH 7TH STREET
PHOENIXAZ8501407/01/2020  
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09237 9856 W. PEORIA AVE.
PEORIAAZ8534510/01/2020  
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09306 19505 N SUNRISE BLVD
SURPRISEAZ8537407/01/2021  
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09294 9172 W UNION HILLS DR
PEORIAAZ8538207/01/2021 01/14/2025
CH093030ARIZONA CVS STORES, L.L.C.DBA: CVS/PHARMACY # 09230 19602 R H JOHNSON
SUN CITY WESTAZ8537504/01/2022  
CH093030AVELLA OF DEER VALLEY, INC. #38DBA AVELLA SPECIALTY PHARMACY 24416 N. 19TH AVE
PHOENIXAZ8508507/01/2017 03/29/2022
CH093030AVELLA OF PHOENIX III1101 N CENTRAL AVE., STE. 102
PHOENIXAZ8500407/01/2017 03/29/2022
CH093030AVELLA OF SACRAMENTO, INC.2288 AUBURN BLVD #102
SACRAMENTOCA9582104/01/2018 03/29/2022
CH093030AVELLA OF SCOTTSDALE9777 N 91ST ST #C102
SCOTTSDALEAZ8525807/01/2017 03/29/2022
CH093030AVELLA OF SCOTTSDALE, INC.9777 N 91ST ST # C102
SCOTTSDALEAZ85258-508704/29/2020 03/29/2022
CH09303NAZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503404/01/2019 07/01/2019
CH093030AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503407/23/2019 01/04/2023
CH09303GBASHA'S UNITED DRUG #1207586 W THUNDERBIRD RD
PEORIAAZ85381-607704/01/2008 09/28/2017
CH093030BASHAS UNITED DRUG #851920 WEST CHANDLER BLVD
CHANDLERAZ8522407/01/2015 10/19/2018
CH09303BBASHAS UNITED DRUG #851920 WEST CHANDLER BLVD
CHANDLERAZ8522405/23/2011 09/29/2017
CH093030BASHAS' #55RALEY'S ARIZONA LLC 275 N TEGNER ST
STE 17
WICKENBURGAZ8539004/16/2025  
CH093030BASHAS' UNITED DRUG275 N TEGNER UNIT 1
WICKENBURGAZ8539007/01/2015  
CH09303DBASHAS' UNITED DRUG275 N TEGNER UNIT 1
WICKENBURGAZ8539007/01/2000 09/29/2017
CH093030BIOPLUS SPECIALTY PHARMACY, INC3200 LAKE EMMA RD UNIT 1000
LAKE MARYFL3274604/01/2022  
CH093030CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2021  
CH093030CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2021  
CH093030CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2021 02/20/2025
CH093030CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2021 02/20/2025
CH093030CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2021 02/20/2025
CH093030CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2021  
CH093030CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2021  
CH093030CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813307/01/2021 02/20/2025
CH093030CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237407/01/2020 02/20/2025
CH093030CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2021  
CH093030COMMUNITY MEDICAL CENTER PHARMACY610 GATEWAY CENTER WAY STE A - E
SAN DIEGOCA92102-454801/01/2018 04/12/2018
CH093030CURANT HEALTH FLORIDA, LLC11001 ROOSEVELT BLVD N STE 1400
ST PETERSBURGFL3371611/29/2022  
CH093030CURANT HEALTH GEORGIA LLCCURANT HEALTH 200 TECHNOLOGY CT SE BLDG 200
SUITE B
SMYRNAGA30082-525011/29/2022  
CH093030CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2021  
CH093030CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2021  
CH093030CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2021  
CH093030CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/01/2019  
CH093030DELIVERCARERX PHARMACY LLCDELIVERCARERX PHARMACY LLC 1471 E BUSINESS CENTER DR
STE 200
MT PROSPECTIL6005601/01/2018 03/11/2019
CH093030DIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268304/29/2020 01/14/2022
CH093030ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/01/2025  
CH093030EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/01/2025  
CH093030FRY'S FOOD & DRUG #67413982 W. WADDELL ROAD
SURPRISEAZ8537904/01/2015 01/12/2018
CH09303EFRY'S FOOD & DRUG #67413982 W. WADDELL ROAD
SURPRISEAZ8537906/21/2011 09/29/2017
CH093030FRY'S FOOD & DRUG #67413982 W. WADDELL ROAD
SURPRISEAZ8537910/01/2020  
CH093030FRY'S FOOD AND DRUG #8619403 N. RH JOHNSON BLVD
SUN CITYAZ8537504/01/2022  
CH093030FRY'S PHARMACY #615THE KROGER CO 1455 N HIGLEY RD
GILBERTAZ85234-264804/01/2022  
CH093030FRY'S PHARMACY #65725401 N LAKE PLEASANT PKWY
PEORIAAZ8538304/01/2022 01/29/2025
CH093030FRY'S PHARMACY #66713730 W CAMELBACK RD
LITCHFIELD PARKAZ8534004/01/2022 02/08/2023
CH093030FRY'S PHARMACY #6812929 E OCOTILLO RD
CHANDLERAZ8524904/01/2022 02/08/2023
CH093030FRY'S PHARMACY #6862724 S SIGNAL BUTTE RD
MESAAZ8520904/01/2022 02/08/2023
CH093030FRY'S PHARMACY #69219600 W. INDIAN SCHOOL RD
BUCKEYEAZ8539604/01/2022  
CH093030GENOA A QOL HEALTHCARE COMPANY LLC  15317 W BELL RD
SUITE 106
SURPRISEAZ85374-387710/01/2015 03/14/2017
CH093030GENOA HEALTHCARE LLC1035 E JEFFERSON ST STE P1
PHOENIXAZ8503404/01/2022 01/26/2023
CH093030GENOA HEALTHCARE LLC1255 W BASELINE RD STE 138
MESAAZ8520204/01/2022  
CH093030GENOA HEALTHCARE LLC460 NORTH MESA DR STE 201 SUITE 201P
MESAAZ8520104/01/2022  
CH093030GENOA HEALTHCARE LLC11221 N 28TH DR STE 2 BLDG E
PHOENIXAZ8502904/01/2022 11/27/2024
CH093030GENOA HEALTHCARE, LLC1705 W MAIN ST
MESAAZ85201-692010/01/2015 02/17/2022
CH093030GENOA HEALTHCARE, LLC1705 W MAIN ST
MESAAZ85201-692004/01/2022 03/29/2022
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 01743 13870 W. GREENWAY RD.
SURPRISEAZ8537407/01/2015 12/31/2016
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05477 15474 W. GREENWAY RD.
SURPRISEAZ8537407/01/2015 12/31/2016
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05477 15474 W. GREENWAY RD.
SURPRISEAZ8537401/01/2018  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 01743 13870 W. GREENWAY RD.
SURPRISEAZ8537401/01/2018  
CH093030GERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY #5530 15300 N. COTTON LANE
SURPRISEAZ8538804/01/2018  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07262 18460 N. 7TH ST.
PHOENIXAZ8502207/01/2019 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05849 990 E. PECOS RD.
CHANDLERAZ8522507/01/2019 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05778 4040 N. 19TH AVE.
PHOENIXAZ8501507/01/2019  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 06718 5835 W. INDIAN SCHOOL RD.
PHOENIXAZ8503107/01/2019  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05315 2005 N. DOBSON RD.
CHANDLERAZ8522407/01/2019  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05892 5050 W. BASELINE RD.
LAVEENAZ8533907/01/2019  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07849 1015 E. RAY RD.
CHANDLERAZ8522507/01/2019 03/01/2021
CH093030GERMAN DOBSON CVS, L.L.C.CVS/PHARMACY # 2963 711 E. INDIAN SCHOOL RD.
PHOENIXAZ8501407/01/2019  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07860 1615 E. BASELINE RD.
PHOENIXAZ8504207/01/2019  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 09205 802 S. MILL AVE.
TEMPEAZ8528107/01/2019 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.CVS/PHARMACY # 2963 711 E. INDIAN SCHOOL RD.
PHOENIXAZ8501407/01/2019 08/01/2019
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00040 1424 W BASELINE RD
TEMPEAZ8528307/01/2019 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00033 1750 E BROADWAY RD
TEMPEAZ8528207/01/2019  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 09222 4275 W. THOMAS RD.
PHOENIXAZ8501907/01/2019  
CH093030GERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY #10229 280 N. AVONDALE BLVD
AVONDALEAZ8532307/01/2019  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 03500 1625 N. 44TH ST.
PHOENIXAZ8500807/01/2019  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 06862 1850 W. DUNLAP AVE.
PHOENIXAZ8502107/01/2019 01/26/2023
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 01759 10 E DUNLAP AVE
PHOENIXAZ8502001/01/2020  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07872 7499 W. BETHANY HOME RD.
GLENDALEAZ8530301/01/2020 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 08366 1610 E CAMELBACK RD
PHOENIXAZ8501604/01/2020 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17024 2140 E BASELINE RD
PHOENIXAZ8504204/01/2020  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00086 1686 E FLORENCE BLVD
CASA GRANDEAZ8512207/01/2020 01/26/2023
CH093030GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17418 5715 N 19TH AVE
PHOENIXAZ8501507/01/2020  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07836 1151 E. MCKELLIPS RD.
MESAAZ8520310/01/2020 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17256 1800 E RIO SALADO PKWY STE 120
TEMPEAZ8528110/01/2020 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05779 360 N. VAL VISTA DR.
MESAAZ8521310/01/2020  
CH093030GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16765 1230 S LONGMORE AVE
MESAAZ8520210/01/2020  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07115 7530 W. CACTUS RD.
PEORIAAZ8538110/01/2020  
CH093030GERMAN DOBSON CVS, L.L.C.CVS/PHARMACY #10616 7547 E. SOUTHERN AVE.
MESAAZ8520907/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17406 10404 N 43RD AVE
GLENDALEAZ8530207/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07263 10707 W. CAMELBACK RD.
PHOENIXAZ8503707/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05026 1212 S. GREENFIELD RD.
MESAAZ8520607/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 16073 1135 S GILBERT RD
MESAAZ8520407/01/2021 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 08365 2428 S VAL VISTA DR
GILBERTAZ8529507/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.CVS PHARMACY # 17075 5110 S POWER RD
MESAAZ8521207/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05814 9950 E. GUADALUPE RD.
MESAAZ8521207/01/2021 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 09283 180 N. DOBSON RD.
CHANDLERAZ8522407/01/2021 01/26/2023
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07078 3303 S. RURAL
TEMPEAZ8528207/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 01720 21201 EAST OCOTILLO RD.,
QUEEN CREEKAZ8514207/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 04795 6015 E. BROWN ROAD
MESAAZ8520507/01/2021 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00069 8332 W THUNDERBIRD RD
PEORIAAZ8538107/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 07116 1855 W. THUNDERBIRD RD.
PHOENIXAZ8502307/01/2021 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 03436 2809 S. SOSSAMAN RD.
MESAAZ8521207/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00007 9901B W THUNDERBIRD BLVD
SUN CITYAZ8535107/01/2021  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 00193 4990 S. ARIZONA AVE.
CHANDLERAZ8524804/01/2022  
CH093030GERMAN DOBSON CVS, L.L.C.CVS/PHARMACY # 10928 909 EAST APACHE BLVD
TEMPEAZ8528104/01/2022 01/14/2025
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 05029 9230 E. BROADWAY RD.
MESAAZ8520804/01/2022  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 01716 21087 W. MAIN ST.
BUCKEYEAZ8539601/01/2024  
CH093030GERMAN DOBSON CVS, L.L.C.DBA: CVS/PHARMACY # 06719 44274 WEST-SMITH ENKE RD.
MARICOPAAZ85138-271901/01/2024  
CH093030GOODYEAR CVS, L.L.C.DBA: CVS/PHARMACY # 03749 2840 N. DYSART RD.
GOODYEARAZ8539507/01/2019  
CH09303NM.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312604/01/2019 07/01/2019
CH093030M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312607/23/2019 01/04/2023
CH093030OPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502904/01/2022 11/27/2024
CH093030OPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520401/01/2024  
CH093030OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/29/2020  
CH093030OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824904/01/2022  
CH093030OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/01/2022 02/17/2025
CH093030OPTUM PHARMACY 705, LLC3539 BLUECUTT RD
COLUMBUSMS3970504/01/2022 02/17/2025
CH093030OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140104/29/2020  
CH093030OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508504/29/2020 01/14/2022
CH093030OPTUM PHARMACY 805, INC1101 N CENTRAL AVE, STE 102
PHOENIXAZ85004-182904/29/2020 03/29/2022
CH093030OPTUM PHARMACY 806, INC.2288 AUBURN BLVD STE. 102
SACRAMENTOCA95821-161807/17/2020 03/29/2022
CH093030OPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660804/01/2022  
CH093030OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983804/01/2022  
CH09303NPILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310104/01/2019 07/01/2019
CH093030PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310107/23/2019 01/04/2023
CH093030PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDOFL32819-999207/01/2019 10/03/2022
CH093030PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2021  
CH093030PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #3129 1002 EAST MCDOWELL ROAD
PHOENIXAZ8500607/01/2020  
CH093030PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681307/01/2021  
CH093030PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2021  
CH093030PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2021  
CH09303BQOL MEDS  1705 WEST MAIN ST
MESAAZ8520110/08/2012 09/29/2017
CH09303EQOL MEDS  15317 W BELL RD
STE 106
SURPRISEAZ8537410/03/2012 09/29/2017
CH093030SAFEWAY INCSAFEWAY PHARMACY #1654 4811 N 83RD AVE
PHOENIXAZ8503301/01/2017 01/07/2025
CH093030SAFEWAY INCSAFEWAY PHARMACY #1584 1999 W WICKENBURG WAY
WICKENBURGAZ8539001/01/2017  
CH093030SAFEWAY INCSAFEWAY PHARMACY #1717 1960 WEST MAIN STREET
MESAAZ8520101/01/2019  
CH093030SAFEWAY INCSAFEWAY PHARMACY #2699 13828 WEST WADDELL ROAD
SURPRISEAZ8537907/01/2019  
CH093030SAFEWAY INCSAFEWAY PHARMACY #1997 17049 W BELL RD
SURPRISEAZ8537407/01/2019 01/07/2025
CH093030SAFEWAY INCSAFEWAY PHARMACY #0236 10926 W BELL RD
SUN CITYAZ8535110/01/2019  
CH093030SAFEWAY INCSAFEWAY PHARMACY #1510 20205 NORTH 67TH AVE.
GLENDALEAZ8530810/01/2019 01/07/2025
CH093030SAFEWAY INCSAFEWAY PHARMACY #0240 3450 W BELL RD
PHOENIXAZ85053-292610/01/2019 01/07/2025
CH093030SAFEWAY INCSAFEWAY PHARMACY #1515 810 E. GLENDALE AVENUE
PHOENIXAZ8502010/01/2019 11/02/2020
CH093030SAFEWAY INCSAFEWAY PHARMACY #0253 3185 W. APACHE TRAIL
APACHE JUNCTIONAZ8512010/01/2019 03/01/2021
CH093030SAFEWAY INCSAFEWAY PHARMACY #2097 4747 E. GREENWAY ROAD
PHOENIXAZ8503210/01/2019 11/02/2020
CH093030SAFEWAY INCSAFEWAY PHARMACY #1534 90 S VAL VISTA DR
GILBERTAZ8529610/01/2019 01/07/2025
CH093030SAFEWAY INCSAFEWAY PHARMACY #2709 5035 W. BASELINE RD
PHOENIXAZ8533910/01/2019 01/07/2025
CH093030SAFEWAY INCSAFEWAY PHARMACY #2054 13503 CAMINO DEL SOL
SUN CITY WESTAZ8537510/01/2019  
CH093030SAFEWAY INCSAFEWAY PHARMACY #1979 13440 N. 7TH STREET
PHOENIXAZ85022-484410/01/2019 01/07/2025
CH093030SAFEWAY INCSAFEWAY PHARMACY #1536 401 EAST HIGHWAY260
PAYSONAZ8554110/01/2019 11/02/2020
CH093030SAFEWAY INCSAFEWAY PHARMACY #1566 4970 S. ALMA SCHOOL
CHANDLERAZ8524810/01/2019 03/01/2021
CH093030SAFEWAY INCSAFEWAY PHARMACY #1662 10641 W. OLIVE AVENUE
PEORIAAZ8534510/01/2019 01/07/2025
CH093030SAFEWAY INCSAFEWAY PHARMACY #1841 12320 N. 83RD AVENUE
PEORIAAZ8538110/01/2019  
CH093030SAFEWAY INCSAFEWAY PHARMACY #2676 9101 E BASELINE RD
MESAAZ8520910/01/2019 01/14/2020
CH093030SAFEWAY INCSAFEWAY PHARMACY #0752 4747 E. ELLIOT ROAD
PHOENIXAZ8504410/01/2019 03/01/2021
CH093030SAFEWAY INCSAFEWAY PHARMACY #2644 1855 N POWER RD
MESAAZ8520510/01/2019 03/01/2021
CH093030SAFEWAY INCSAFEWAY PHARMACY #1511 14175 W INDIAN SCHOOL RD.
GOODYEARAZ85395-840710/01/2019 03/01/2021
CH093030SAFEWAY INCSAFEWAY PHARMACY #1605 1060 E RAY ROAD
CHANDLERAZ8522510/01/2019  
CH093030SAFEWAY INCSAFEWAY PHARMACY #1706 1637 N TREKELL RD
CASA GRANDEAZ8512210/01/2019 03/01/2021
CH093030SAFEWAY INCSAFEWAY PHARMACY #1637 3622 E SOUTHERN AVENUE
MESAAZ8520610/01/2019 11/02/2020
CH093030SAFEWAY INCSAFEWAY PHARMACY #2618 440 N ESTRELLA PARKWAY
GOODYEARAZ8533810/01/2019  
CH093030SAFEWAY INCSAFEWAY PHARMACY #3151 9890 S. ESTRELLA PARKWAY
GOODYEARAZ8533801/01/2020  
CH093030SAFEWAY INCSAFEWAY PHARMACY #2799 28455 N VISTANCIA BLVD
PEORIAAZ8538301/01/2020 03/01/2021
CH093030SAFEWAY INCSAFEWAY PHARMACY #2835 3325 NORTH HUNT HIGHWAY
FLORENCEAZ8513201/01/2020 03/01/2021
CH093030SAFEWAY INCSAFEWAY PHARMACY #2821 3800 WEST HAPPY VALLEY ROAD
GLENDALEAZ8531001/01/2020 11/02/2020
CH093030SMITH FOOD & DRUG CENTERSDBA FRY FOOD & DRUG #23 5941 E MCKELLIPS
MESAAZ8521504/01/2022  
CH093030SMITH FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #12 18420 N. 19TH AVE
PHOENIXAZ8502304/01/2022 02/08/2023
CH093030SMITH'S FOOD & DRUGDBA FRY'S FOOD AND DRUG #113 1245 W MAIN STREET
MESAAZ8520101/01/2017  
CH093030SMITH'S FOOD & DRUG CENTERS, INC.FRY'S PHARMACY #112 1575 N DYSART ROAD
AVONDALEAZ8539204/01/2015  
CH09303HSMITH'S FOOD & DRUG CENTERS, INC.FRY'S PHARMACY #112 1575 N DYSART ROAD
AVONDALEAZ8539205/24/2011 09/29/2017
CH093030SMITH'S FOOD & DRUG CENTERS, INC.D/B/A FRYS PHARMACY #45 7455 W CACTUS RD
PEORIAAZ8538110/01/2020  
CH093030SMITH'S FOOD & DRUG CTRDBA FRY'S FOOD AND DRUG #61 15510 W BELL RD
SURPRISEAZ8537404/01/2015  
CH093030SMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD AND DRUG #136 4329 W NORTHERN AVE
GLENDALEAZ8530104/01/2015  
CH09303GSMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD AND DRUG #136 4329 W NORTHERN AVE
GLENDALEAZ8530105/16/2011 09/29/2017
CH093030SMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD AND DRUG #123 2727 E BROADWAY
MESAAZ8520410/01/2020 01/29/2025
CH093030SMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD AND DRUG #122 10660 N.W. GRAND AVE
SUN CITYAZ8535104/01/2022 01/29/2025
CH093030SMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD AND DRUG #127 4202 WEST CACTUS RD
PHOENIXAZ8502904/01/2022 02/08/2023
CH093030SMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD STORES #84 542 E. HUNT HWY
SAN TAN VALLEYAZ8514304/01/2022 02/08/2023
CH093030SMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD AND DRUG #126 6601 W. INDIAN SCHOOL RD.
PHOENIXAZ8503304/01/2022 02/08/2023
CH093030SMITH'S FOOD & DRUG CTRSDBA FRY FOOD & DRUG #74 8375 W. DEER VALLEY ROAD
PEORIAAZ85382-246004/01/2022 02/08/2023
CH093030SMITH'S FOOD & DRUG CTRSDBA FRY'S FOOD STORES #89 11425 W BUCKEYE RD
AVONDALEAZ8532304/01/2022  
CH093030SMITH'S FOOD & DRUG CTRSDBA FRYS PHARMACY #72 87 E. WILLIAMS FIELD RD
GILBERTAZ8529504/01/2022 02/08/2023
CH093030SMITH'S FOOD AND DRUGDBA FRY'S FOOD AND DRUG #114 9245 W. UNION HILLS
PEORIAAZ8538204/01/2022  
CH093030SMITH'S FOOD AND DRUG CTRDBA FRY'S FOOD & DRUG #101 3232 S MILL AVENUE
TEMPEAZ8528204/01/2022 02/08/2023
CH093030SMITH'S FOOD DRUG CENTERSDBA FRYS FOOD AND DRUG #675 1300 S WATSON ROAD
BUCKEYEAZ8532604/01/2015  
CH09303CSMITH'S FOOD DRUG CENTERSDBA FRYS FOOD AND DRUG #675 1300 S WATSON ROAD
BUCKEYEAZ8532608/09/2011 09/29/2017
CH093030SMITH'S FOOD DRUG CENTERS, INCFRYS PHARMACY #672 20797 N JOHN WAYNE PKWY
MARICOPAAZ8513904/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUGDBA FRY'S PHARMACY #115 435 S. ELLSWORTH
MESAAZ8520804/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERDBA FRYS FOOD & DRUG #87 5140 W BASELINE RD
LAVEENAZ8533904/01/2022  
CH093030SMITHS FOOD & DRUG CENTERSDBA FRY'S PHARMACY #607 5100 S. MCCLINTOCK DR.
TEMPEAZ8528204/01/2015 01/12/2018
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #623 1815 W. GLENDALE AVENUE
PHOENIXAZ8502101/01/2017  
CH09303BSMITHS FOOD & DRUG CENTERSDBA FRY'S PHARMACY #607 5100 S. MCCLINTOCK DR.
TEMPEAZ8528205/16/2011 09/29/2017
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #56 9043 W OLIVE
PEORIAAZ8534510/01/2020  
CH093030SMITHS FOOD & DRUG CENTERSDBA FRY'S FOOD & DRUG #610 4230 W. MCDOWELL ROAD
PHOENIXAZ8500910/01/2020  
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD AND DRUG # 668 985 E RIGGS ROAD
CHANDLERAZ8524904/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERSD/B/A FRY'S PHARMACY #665 150 E OLD WEST HIGHWAY
APACHE JUNCTIONAZ8511904/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERSFRYS FOOD & DRUG #641 3511 W. PEORIA AVENUE
PHOENIXAZ8502904/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #617 2727 W. BELL ROAD
PHOENIXAZ8505304/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #66 10675 W INDIAN SCHOOL ROAD
AVONDALEAZ8539204/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD AND DRUGS # 79 2626 S 83 AVENUE
PHOENIXAZ8504304/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #26 5116 W OLIVE
GLENDALEAZ8530204/01/2022  
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #60 20220 N 59 AVENUE
GLENDALEAZ8530804/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #22 1835 E GUADALUPE
TEMPEAZ8528304/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #40 3421 W THUNDERBIRD ROAD
PHOENIXAZ8505304/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERSDBA FRY'S PHARMACY #607 5100 S. MCCLINTOCK DR.
TEMPEAZ8528204/01/2022  
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #52 855 W WARNER ROAD
GILBERTAZ8523304/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #64 714 S VAL VISTA DRIVE
GILBERTAZ8529604/01/2022  
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #612 4707 E. SHEA BLVD
PHOENIXAZ8502804/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #6 5771 W THUNDERBIRD
GLENDALEAZ8530604/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #73 6625 W. HAPPY VALLEY ROAD
GLENDALEAZ8531004/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #28 4315 W BELL ROAD
GLENDALEAZ8530804/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #625 6611 W. BELL ROAD
GLENDALEAZ8530804/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #5 7770 E MCDOWELL
SCOTTSDALEAZ8525704/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #10 4353 W BETHANY HOME ROAD
GLENDALEAZ8530104/01/2022  
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG 628 3949 E. CHANDLER BLVD
PHOENIXAZ8504404/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #627 9900 S. RURAL ROAD
TEMPEAZ8528404/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #624 1845 E. BASELINE ROAD
GILBERTAZ8523404/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #619 8325 W. INDIAN SCHOOL ROAD
PHOENIXAZ8503304/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #62 554 W BASELINE
MESAAZ8521004/01/2022  
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #618 3246 E. BELL ROAD
PHOENIXAZ8503204/01/2022 02/08/2023
CH093030SMITHS FOOD & DRUG CENTERSFRYS FOOD & DRUG #622 1935 N. STAPLEY DRIVE
MESAAZ8520304/01/2022  
CH093030SMITHS FOOD & DRUG CENTERSDBA FRYS FOOD & DRUG #611 4440 E. MAIN STREET
MESAAZ8520504/01/2022 01/29/2025
CH093030SMITHS FOOD & DRUG CTRSDBA FRY'S FOOD AND DRUG #121 4025 E THUNDERBIRD RD
PHOENIXAZ8503204/01/2022 02/08/2023
CH093030SMITHS FOOD AND DRUG CENTERSDBA FRYS FOOD STORES #11 6710 W. BETHANY HOME RD
GLENDALEAZ8530304/01/2022  
CH093030SMITHS FOOD AND DRUG CENTERS INCDBA FRYS FOOD STORES #670 6470 S HIGLEY ROAD
GILBERTAZ8529804/01/2022 01/29/2025
CH093030SMITHS FOOD AND DRUG CENTERS INCDBA FRYS FOOD STORES #676 16380 W YUMA ROAD
GOODYEARAZ8533804/01/2022  
CH093030SMITHS FOOD AND DRUG CENTERS INCDBA FRYS FOOD STORES OF AZ #682 155 W COMBS RD
SAN TAN VALLEYAZ8514004/01/2022 02/08/2023
CH093030SMITHS FOOD AND DRUG CENTERS INC.DBA FRYS FOOD STORES #680 15215 N COTTON LANE
SURPRISEAZ8538801/01/2017  
CH093030SMITHS FOOD AND DRUG CTR INCDBA FRY'S FOOD AND DRUG #75 3261 E. PECOS RD
GILBERTAZ8529704/01/2022 01/29/2025
CH093030THE KROGER CO.FRY'S PHARMACY #128 744 W CAMELBACK ROAD
PHOENIXAZ8501301/01/2017 01/29/2025
CH093030TRUEPILL3121 DIABLO AVE
HAYWARDCA9454504/01/2020 01/04/2023
CH093030VADEN CORPORATIONBUCKEYE HEALTH MART PHARMACY #23 310 MONROE AVE
BUCKEYEAZ8532607/01/2015 06/11/2015
CH09303CVADEN CORPORATIONBUCKEYE HEALTH MART PHARMACY #23 310 MONROE AVE
BUCKEYEAZ8532608/09/2011 09/29/2017
CH093030WAL-MART PHARMACY #10-421815431 WEST GREENWAY ROAD
SURPRISEAZ8537407/01/2015 08/15/2016
CH093030WAL-MART PHARMACY #10-421815431 WEST GREENWAY ROAD
SURPRISEAZ8537401/01/2018  
CH093030WAL-MART PHARMACY 10-15337975 W PEORIA AVE
PEORIAAZ8534507/01/2018  
CH093030WAL-MART PHARMACY 10-17461380 WEST ELLIOTT ROAD
TEMPEAZ8528407/01/2020 12/19/2024
CH093030WAL-MART PHARMACY 10-21124915 NORTH PIMA ROAD
SCOTTSDALEAZ8525110/01/2020 02/08/2023
CH093030WAL-MART PHARMACY 10-21131607 WEST BETHANY HOME RD
PHOENIXAZ8501510/01/2020  
CH093030WAL-MART PHARMACY 10-2482857 N DOBSON
MESAAZ8520107/01/2015 08/15/2016
CH093030WAL-MART PHARMACY 10-2482857 N DOBSON
MESAAZ8520101/01/2018  
CH093030WAL-MART PHARMACY 10-25121825 W BELL ROAD
PHOENIX (NORTH)AZ8502307/01/2018  
CH093030WAL-MART PHARMACY 10-27681955 SO. STAPLEY DRIVE
MESAAZ8520407/01/2018 12/19/2024
CH093030WAL-MART PHARMACY 10-277713770 WEST BELL ROAD
SURPRISEAZ8537407/01/2015 08/15/2016
CH093030WAL-MART PHARMACY 10-277713770 WEST BELL ROAD
SURPRISEAZ8537401/01/2018 12/19/2024
CH093030WAL-MART PHARMACY 10-324118551 N 83RD AVE
GLENDALEAZ8530807/01/2018  
CH093030WAL-MART PHARMACY 10-34071060 SOUTH WATSON
BUCKEYEAZ8532607/01/2015 08/15/2016
CH093030WAL-MART PHARMACY 10-34071060 SOUTH WATSON
BUCKEYEAZ8532601/01/2018  
CH093030WAL-MART PHARMACY 10-3799240 WEST BASELINE ROAD
MESAAZ8521007/01/2015 08/15/2016
CH093030WAL-MART PHARMACY 10-3799240 WEST BASELINE ROAD
MESAAZ8521001/01/2018  
CH093030WAL-MART PHARMACY 10-433612900 WEST THUNDERBIRD
EL MIRAGEAZ8533507/01/2015 08/15/2016
CH093030WAL-MART PHARMACY 10-433612900 WEST THUNDERBIRD
EL MIRAGEAZ8533501/01/2018  
CH093030WAL-MART PHARMACY 10-51245605 W NORTHERN AVE
GLENDALE (MANISTEE)AZ8530107/01/2015 08/15/2016
CH093030WAL-MART PHARMACY 10-51245605 W NORTHERN AVE
GLENDALE (MANISTEE)AZ8530107/01/2018  
CH093030WAL-MART PHARMACY 10-51895250 WEST INDIAN SCHOOL RD
PHOENIX (MARYVALE)AZ8503107/01/2020  
CH093030WAL-MART PHARMACY 10-52575122 E UNIVERSITY DR
MESAAZ8520507/01/2018 02/08/2023
CH093030WAL-MART PHARMACY 10-53306145 NORTH 35TH AVENUE
PHOENIXAZ8501701/01/2018  
CH093030WAL-MART PHARMACY 10-5332730 E MCKELLIPS RD
MESA (HORNE)AZ8520307/01/2018  
CH093030WAL-MART PHARMACY 10-542914111 N. PRASADA GATEWAY AVE
SURPRISEAZ8538807/01/2015 08/15/2016
CH093030WAL-MART PHARMACY 10-542914111 N. PRASADA GATEWAY AVE
SURPRISEAZ8538801/01/2018  
CH093030WALGREEN ARIZONA DRUG COWALGREENS SPECIALTY PHARMACY #21213 5149 W THUNDERBIRD RD.
GLENDALEAZ8530604/01/2018  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06806 17088 W BELL RD
SURPRISEAZ8537404/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03048 9050 W UNION HILLS DRIVE
PEORIAAZ8538204/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03387 10705 W INDIAN SCHOOL
AVONDALEAZ8539204/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04620 15490 W BELL RD.
SURPRISEAZ8537404/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04791 14285 W GRAND AVENUE
SURPRISEAZ85374-429704/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05504 4249 W GLENDALE AVE
PHOENIXAZ8505104/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06128 19003 N R H JOHNSON BLVD
SUN CITY WESTAZ8537504/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06428 15385 N DYSART ROAD
EL MIRAGEAZ8533504/01/2017 03/02/2020
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07026 12244 W CACTUS RD
EL MIRAGEAZ8533504/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07933 15514 W WADDELL RD
SURPRISEAZ8537904/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 09175 23477 W YUMA RD
BUCKEYEAZ8532604/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 10349 14418 W MEEKER BLVD
SUITE 101
SUN CITY WESTAZ85375-529004/01/2017 08/01/2019
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS #11470 25073 W SOUTHERN AVE
BUCKEYEAZ8532604/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA WALGREENS #12087 13723 N. LITCHFIELD RD.
SURPRISEAZ8537904/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03670 1159 E. SOUTHERN AVE.
MESAAZ8520407/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04139 3450 W. DUNLAP AVE
PHOENIXAZ8505107/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05039 746 W UNIVERSITY DR
MESAAZ8520107/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06177 1135 N MESA DRIVE
MESAAZ8520107/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06784 2024 W MAIN STREET
MESAAZ85201-680207/01/2017  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 11182 1130 W. SOUTHERN AVE
MESAAZ8521007/01/2017  
CH09303EWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06428 15385 N DYSART ROAD
EL MIRAGEAZ8533508/31/2006 12/30/2016
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 01197 1745 E SOUTHERN AVE
TEMPEAZ85282-762504/01/2018  
CH093030WALGREEN ARIZONA DRUG CO.WALGREENS SPECIALTY PHARMACY #16431 2302 N. CENTRAL AVE.
SUITE 7
PHOENIXAZ8500404/01/2018  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07387 10710 WEST MCDOWELL ROAD
AVONDALEAZ8539201/01/2019  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06095 9045 W INDIAN SCHOOL RD
PHOENIXAZ8503701/01/2019 02/17/2022
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02243 387 N ESTRELLA PKWY
GOODYEARAZ8533801/01/2019  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05568 10707 W PEORIA AVE
SUN CITYAZ8535101/01/2019  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03657 3361 NORTH LITCHFIELD RD
GOODYEARAZ8539501/01/2019  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS #12334 1654 N PEBBLE CREEK PKWY
GOODYEARAZ8539501/01/2019  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07582 13014 W CAMELBACK ROAD
LITCHFIELD PARKAZ8534001/01/2019  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05776 1451 N DYSART ROAD
AVONDALEAZ8532301/01/2019  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04909 2921 N. 83RD AVE.
PHOENIXAZ8503301/01/2019  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03591 2811 EAST BROADWAY ROAD
MESAAZ8520401/01/2019  
CH09303NWALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03464 3402 N CENTRAL AVE
PHOENIXAZ8501204/01/2019 07/01/2019
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03464 3402 N CENTRAL AVE
PHOENIXAZ8501207/23/2019  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 09202 1142 W GUADALUPE RD
MESAAZ85210-760204/01/2020  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 01272 5101 WEST INDIAN SCHOOL
PHOENIXAZ8503104/01/2020  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS #12386 9800 S. ESTRELLA PKWY.
GOODYEARAZ8533807/01/2020  
CH093030WALGREEN ARIZONA DRUG CO.WALGREENS CENTRAL FILL #21372 120 N 83RD AVE
STE 200
TOLLESONAZ8535310/01/2021  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 04228 5125 W. NORTHERN AVE.
GLENDALEAZ8530104/01/2022  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06736 4410 W CACTUS ROAD
GLENDALEAZ85304-233204/01/2022  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03427 7448 W THUNDERBIRD RD
PEORIAAZ8538104/01/2022  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 01969 6006 N 67TH AVE
GLENDALEAZ8530104/01/2022  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03003 6690 W. UNION HILLS
GLENDALEAZ8530801/01/2023  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 00813 15442 N 99TH AVENUE
SUN CITYAZ8535101/01/2023  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05668 8301 W CAMELBACK
PHOENIXAZ8503701/01/2023  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS DRUG # 04020 5895 W. PEORIA AVENUE
GLENDALEAZ8530201/01/2023  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 06872 2930 N 67TH AVE
PHOENIXAZ8503301/01/2023  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 07663 8280 W LOWER BUCKEYE ROAD
PHOENIXAZ8504301/01/2023  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 03789 3605 E THOMAS RD
PHOENIXAZ8501801/01/2023  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05222 9040 W. PEORIA AVE.
PEORIAAZ8534501/01/2023  
CH093030WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 05937 4315 W MCDOWELL RD
PHOENIXAZ8503501/01/2024  
CH093030WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700807/01/2019 03/30/2022
CH093030WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/01/2019  
CH093030WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/01/2019  
CH093030WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/01/2019  
CH093030WALGREENS.COM, INC.DBA: WALGREENS 2225 S. PRICE ROAD
CHANDLERAZ8528601/01/2023  
CH093030Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
CH093030WESTERN PHARMACY GROUP LLCDBA COMMUNITY MEDICAL CENTER PHARMACY 610 GATEWAY CENTER WAY
SUITES A--E
SAN DIEGOCA9210204/16/2018 07/21/2022
CH093030XPRESS CARE PHARMACY #24290 S MILLER RD STE 101
BUCKEYEAZ85326-630704/01/2017 08/24/2018
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingNPI: NumberDeleteChange Request1144093972 (AZ) 3/13/2025 6:29 PM
Medicaid BillingNPI: NumberInsertChange Request 13561988323/13/2025 6:29 PM
Medicaid BillingNPI: StateInsertChange Request AZ3/13/2025 6:29 PM
DetailsLast Recertification DateUpdateRecertification2/20/2024 12:09:29 PM2/12/2025 3:06:28 PM2/12/2025 3:06 PM
Medicaid BillingNPI: NumberInsertChange Request 11440939729/19/2024 11:07 AM
Medicaid BillingNPI: StateInsertChange Request AZ9/19/2024 11:07 AM
Medicaid BillingMedicaid: NumberDeleteChange Request407093 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request381858 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request956445 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request830182 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request432048 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request204924 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request431797 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request340582 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request430824 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request505464 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request435337 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request428747 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request934699 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request350565 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request379291 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request279238 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request298755 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request008586 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request004793 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request004147 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request545591 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request532871 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request568353 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request405844 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request553417 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request548702 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request005756 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request498506 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request557497 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request451939 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request162327 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request000867 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request556895 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request405253 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request084637 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request521827 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request796849 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request083284 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request082796 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request449932 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request087581 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request463134 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request528696 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request467628 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request079424 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request099583 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request100189 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request098696 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request981789 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request530034 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request561814 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request096948 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request081348 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request097337 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request731373 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request091782 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request092230 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request095171 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 9358096/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1569046/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 9357376/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1568986/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4982746/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0077166/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 9356846/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5184086/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 145016/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3341756/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2382646/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 9357466/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1569016/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 9356506/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1479586/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1627336/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2276246/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 9357596/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3111616/17/2024 2:08 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request589327 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request887433 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request243598 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request503881 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request026248 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request581463 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request941121 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request943392 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request669435 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request678832 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request942062 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request385008 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request693294 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request825811 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request828798 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request568279 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request002868 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request706714 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request313987 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request555196 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request045448 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request864565 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request083008 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request864169 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request366701 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request415673 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request939481 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request197352 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request83810 (AZ) 6/17/2024 2:08 PM
Medicaid BillingMedicaid: NumberDeleteChange Request766709 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1962829713 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1275853715 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1508349929 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1720336910 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1225511686 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1922425388 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1184628877 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1265827885 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1003202144 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1083909378 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1730394792 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1558365957 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1851821110 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1104137256 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1023675162 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1891226585 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1558716571 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1295023935 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1316331259 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1538653936 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1629562285 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1457701054 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1134571995 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1518386606 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1356759039 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1932601754 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1700353620 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1972945269 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1447578869 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1548641376 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1235648148 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1922055722 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1942687421 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1497033021 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1992855597 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1861709537 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1194019398 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1629155338 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1508340506 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1487622411 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1619446655 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1508423583 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1053883371 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1801241898 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1407981384 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1205339090 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1902570088 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1912413618 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1942798368 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1336383330 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1548721541 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1679004790 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1124661707 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1134613888 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1609301621 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1992473813 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1295231868 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1730126756 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1558364646 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1235579079 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1134569494 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1306912266 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1982087672 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1275641870 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1093789661 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1821424524 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1114333911 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1871778027 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1538309133 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1295739985 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1639149933 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1427054329 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1225395726 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1740410125 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1427056340 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1912152026 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1205052057 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1588800403 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1356367635 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1467493015 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1437448453 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1184835126 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1457616161 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1538353396 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1689821266 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1477746030 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1013013358 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1790955409 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberDeleteChange Request1255683017 (AZ) 6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 18019544416/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 16994349446/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 13867029426/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 18914541466/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 12750179156/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 18812172486/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 18918534466/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 10134765716/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 17709912916/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 10932273246/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 12052005656/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 11444192846/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15984224536/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 12059947616/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 12358892706/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 14071326736/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 10032934656/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 10837725456/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15281261336/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15682497536/17/2024 2:08 PM
Medicaid BillingNPI: StateInsertChange Request AZ6/17/2024 2:08 PM
DetailsLast Recertification DateUpdateRecertification2/6/2023 3:41:53 PM2/20/2024 12:09:29 PM2/20/2024 12:09 PM
DetailsLast Recertification DateUpdateRecertification2/18/2022 3:41:25 PM2/6/2023 3:41:53 PM2/6/2023 3:41 PM
ContactsPrimary ContactUpdateChange RequestMurray, Amanda C 340B Program Manager Adelante Healthcare 6235833001-1312Murray, Amanda Christine 340b Program Manager Adelante Healthcare 6025833001-0113129/2/2022 12:42 PM
DetailsLast Recertification DateUpdateRecertification2/24/2021 10:34:21 AM2/18/2022 3:41:25 PM2/18/2022 3:41 PM
Medicaid BillingMedicaid: NumberDeleteChange Request406978 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request156714 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request173414 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request155138 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request223359 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request188458 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request007991 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request164622 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request560483 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request178402 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request990831 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request006441 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request507757 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request552698 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request006844 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 09958312/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 10018912/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 09869612/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 98178912/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 53003412/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 56181412/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 09694812/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 08134812/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 09733712/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 73137312/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 09178212/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 09223012/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberInsertChange Request 09517112/20/2021 6:17 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request214954 (AZ) 12/20/2021 6:17 PM
Medicaid BillingMedicaid: NumberDeleteChange Request564983 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1164649141 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1205389988 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1962615856 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1821435579 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1295190304 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1740635721 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1871041418 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1568894152 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1780691915 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1811208770 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1780030742 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1952601908 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 140798138412/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 120533909012/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 190257008812/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 191241361812/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 194279836812/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 133638333012/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 154872154112/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 167900479012/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 112466170712/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 113461388812/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 160930162112/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 199247381312/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberInsertChange Request 129523186812/20/2021 6:17 PM
Medicaid BillingNPI: StateInsertChange Request AZ12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1326421108 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1881015162 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1033342712 (AZ) 12/20/2021 6:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1245643774 (AZ) 12/20/2021 6:17 PM
AddressesBilling AddressUpdateChange RequestADELANTE HEALTHCARE 3033 N. Central Ave Suite 200 PHOENIX, AZ 85012ADELANTE HEALTHCARE 3033 N. Central Ave PHOENIX, AZ 850126/15/2021 11:51 AM
ContactsAuthorizing OfficialUpdateChange RequestBattis, Eric COO Adelante Healthcare 6235833001-1222Cons, Pedro CEO Adelante Healthcare 6235833001-0111055/5/2021 2:53 PM
Medicaid BillingMedicaid: NumberDeleteChange Request829949 (AZ) 4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberDeleteChange Request362109 (AZ) 4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberDeleteChange Request603062 (AZ) 4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 5218274/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 7968494/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0832844/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0827964/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0068444/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 4499324/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0875814/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 4631344/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 5286964/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 4676284/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 0794244/27/2021 10:52 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberDeleteChange Request079178 (AZ) 4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberDeleteChange Request949370 (AZ) 4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberDeleteChange Request590398 (AZ) 4/27/2021 10:52 AM
Medicaid BillingMedicaid: NumberDeleteChange Request141963 (AZ) 4/27/2021 10:52 AM
Medicaid BillingNPI: NumberDeleteChange Request1669678538 (AZ) 4/27/2021 10:52 AM
Medicaid BillingNPI: NumberDeleteChange Request1275034753 (AZ) 4/27/2021 10:52 AM
Medicaid BillingNPI: NumberDeleteChange Request1619360070 (AZ) 4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 19426874214/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 14970330214/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 19928555974/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 18617095374/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 11940193984/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 16291553384/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 19526019084/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 15083405064/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 14876224114/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 16194466554/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 15084235834/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 10538833714/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberInsertChange Request 18012418984/27/2021 10:52 AM
Medicaid BillingNPI: StateInsertChange Request AZ4/27/2021 10:52 AM
Medicaid BillingNPI: NumberDeleteChange Request1477871473 (AZ) 4/27/2021 10:52 AM
Medicaid BillingNPI: NumberDeleteChange Request1508066994 (AZ) 4/27/2021 10:52 AM
Medicaid BillingNPI: NumberDeleteChange Request1902219967 (AZ) 4/27/2021 10:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/24/2021 10:34 AM
Medicaid BillingMedicaid: NumberInsertRecertification 0846372/24/2021 10:34 AM
Medicaid BillingMedicaid: StateInsertRecertification AZ2/24/2021 10:34 AM
Medicaid BillingNPI: NumberInsertRecertification 19220557222/24/2021 10:34 AM
Medicaid BillingNPI: StateInsertRecertification AZ2/24/2021 10:34 AM
Medicaid BillingNPI: NumberDeleteRecertification1184628877 (AZ) 2/24/2021 10:34 AM
DetailsLast Recertification DateUpdateRecertification1/31/2020 12:19:29 PM2/24/2021 10:34:21 AM2/24/2021 10:34 AM
Medicaid BillingMedicaid: NumberDeleteChange Request690281 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request36348 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request435021 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1884588/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0085868/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0047938/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0079918/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0041478/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5455918/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1646228/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5328718/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5683538/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5604838/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1784028/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4058448/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3621098/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 9908318/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5534178/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0064418/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 6030628/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5487028/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0057568/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4985068/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5574978/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5077578/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5526988/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4519398/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1623278/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0008678/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5568958/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4052538/12/2020 1:37 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1532871 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request023808 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request016874 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request536573 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request016858 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request259962 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request174651 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request895672 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request083019 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request547554 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request323382 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request423187 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request241815 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request088865 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request163791 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request056634 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request238916 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request210520 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request719484 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request033401 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request320378 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request345557 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request623525 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request230029 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request147948 (AZ) 8/12/2020 1:37 PM
Medicaid BillingMedicaid: NumberDeleteChange Request283718 (AZ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1235190083 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1912413618 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1629451711 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1942228259 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 18214355798/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 10236751628/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 18912265858/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 12951903048/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 15587165718/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 12950239358/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 13163312598/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 15386539368/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 17406357218/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 18710414188/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 16295622858/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 12750347538/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 15688941528/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 14577010548/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 17806919158/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 16193600708/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 11345719958/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 15183866068/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 13567590398/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 19326017548/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 18112087708/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 17800307428/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 17003536208/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 19729452698/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 14475788698/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 15486413768/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberInsertChange Request 12356481488/12/2020 1:37 PM
Medicaid BillingNPI: StateInsertChange Request AZ8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1215360854 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1194104240 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1740452838 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1942687421 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1811934441 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1720467418 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1851388896 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1962564641 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1386074284 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1306218540 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1164646063 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1720062953 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1801888763 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1073855409 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1437523115 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1659347565 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1699006510 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1992745574 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1083748073 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1194910570 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1811332059 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1366799884 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1326565540 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1790206159 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1710236799 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1689813032 ( ) 8/12/2020 1:37 PM
Medicaid BillingNPI: NumberDeleteChange Request1245344167 ( ) 8/12/2020 1:37 PM
DetailsLast Recertification DateUpdateRecertification1/29/2019 5:46:49 PM1/31/2020 12:19:29 PM1/31/2020 12:19 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/29/2019 11:44 AM
Medicaid BillingMedicaid: NumberInsertChange Request 2987554/29/2019 11:44 AM
Medicaid BillingMedicaid: StateInsertChange Request AZ4/29/2019 11:44 AM
Medicaid BillingNPI: NumberInsertChange Request 11041372564/29/2019 11:44 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 8299493/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 6902813/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 9564453/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 8301823/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4320483/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2049243/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4317973/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3405823/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1734143/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1551383/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4308243/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 5054643/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4353373/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 363483/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4287473/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 4350213/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2233593/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 9346993/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3505653/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3792913/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2792383/31/2019 1:57 PM
Medicaid BillingMedicaid: StateInsertChange Request AZ3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberDeleteChange Request722443 (AZ) 3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberDeleteChange Request895359 (AZ) 3/31/2019 1:57 PM
Medicaid BillingMedicaid: NumberDeleteChange Request988659 (AZ) 3/31/2019 1:57 PM
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Medicaid BillingNPI: NumberDeleteChange Request1558538348 ( ) 3/31/2019 1:57 PM
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Medicaid BillingNPI: NumberDeleteChange Request1114333911 ( ) 3/31/2019 1:57 PM
DetailsLast Recertification DateUpdateRecertification2/8/2018 10:37:58 AM1/29/2019 5:46:49 PM1/29/2019 5:46 PM
AddressesBilling AddressUpdateChange RequestADELANTE HEALTHCARE 9520 W. PALM LANE Suite 200 PHOENIX, AZ 85037ADELANTE HEALTHCARE 3033 N. Central Ave Suite 200 PHOENIX, AZ 850121/7/2019 4:35 PM
ContactsPrimary ContactUpdateProfile Change RequestOlivas, Amanda C 340B Program Coordinator Adelante Healthcare 6235833001-1312Murray, Amanda C 340B Program Manager Adelante Healthcare 6235833001-13121/2/2019 4:34 PM
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DetailsLast Recertification DateUpdateRecertification2/9/2017 12:00:00 AM2/8/2018 10:37:58 AM2/8/2018 10:37 AM
ContactsAuthorizing OfficialUpdate Battis, Eric COO 6235833001-1222Battis, Eric COO Adelante Healthcare 6235833001-12229/25/2017 1:44 PM
ContactsPrimary ContactUpdate Olivas, Amanda 340B Program Coordinator 6235833001-1312Olivas, Amanda C 340B Program Coordinator Adelante Healthcare 6235833001-13129/25/2017 1:35 PM
ContactsAuthorizing OfficialUpdate TAFOYA, AVEIN SAATY CEO 6235833001-1207Battis, Eric COO 6235833001-12224/25/2017 1:33 PM
AddressesMain AddressUpdate  15351 W. Bell Road SURPRISE, AZ 85378 15351 W. Bell Road Surprise, AZ 853742/9/2017 4:46 PM
AddressesMain AddressInsert   15351 W. Bell Road SURPRISE, AZ 853782/9/2017 4:46 PM
ContactsPrimary ContactUpdate ELK, ROBERT CHIEF MEDICAL OFFICER 6235833001-1206Olivas, Amanda 340B Program Coordinator 6235833001-13122/9/2017 4:46 PM
DetailsLast Recertification DateUpdate 3/3/2016 12:00:00 AM2/9/2017 12:00:00 AM2/9/2017 4:45 PM
AddressesBilling AddressInsert  ADELANTE HEALTHCARE 9520 W. PALM LANE Suite 200 PHOENIX, AZ 8503712/27/2016 10:13 AM
ContactsAuthorizing OfficialUpdate Ferreiro, Manuel CFO 6235445131TAFOYA, AVEIN SAATY CEO 6235833001-12073/3/2016 1:24 PM
ContactsPrimary ContactUpdate Van Eynde, Linda PURCHASING COORDINATOR 6235833001-1350ELK, ROBERT CHIEF MEDICAL OFFICER 6235833001-12063/3/2016 1:24 PM
DetailsLast Recertification DateUpdate 3/10/2015 12:00:00 AM3/3/2016 12:00:00 AM3/3/2016 1:24 PM
DetailsLast Recertification DateUpdate 2/10/2014 12:00:00 AM3/10/2015 12:00:00 AM3/10/2015 10:55 AM
DetailsEntity NameUpdate ADELANTE HEALTH CARE, INC.ADELANTE HEALTHCARE, INC.3/31/2014 4:25 PM
DetailsEntity SubnameUpdate ADELANTE HEALTHCARE SURPRISEAdelante Healthcare Surprise3/31/2014 4:25 PM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM2/10/2014 12:00:00 AM2/10/2014 11:36 AM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM3/11/2013 9:48 AM
ContactsPrimary ContactUpdate Young, Ed Controller 6235941343Van Eynde, Linda PURCHASING COORDINATOR 6235833001-13504/25/2012 11:18 AM
ContactsAuthorizing OfficialInsert  Ferreiro, Manuel CFO 62354451313/9/2012 12:19 PM
DetailsComments PublicInsert  3/9/12-Changed contact person (was Ed Young); 12/19/11 - Changed main address from 16560 NORTH DYSART ROAD SURPRISE, AZ 85378, AO info from AVEIN SAATY TAFOYA and contact info from Lisa Sawicke. 10/28/11 - Changed zip code from 85374. 5/13/11 UPDATED ENTITY NAME (WAS CLINICA ADELANTE, INC.); 2/28/11 ADDED BILL ADD3/9/2012 12:19 PM
ContactsPrimary ContactUpdate SAWICKE, LISA PURCHASING MANAGER 6235568860-1350Young, Ed Controller 62359413431/10/2012 2:36 PM
DetailsComments PublicInsert  12/19/11 - Changed main address from 16560 NORTH DYSART ROAD SURPRISE, AZ 85378, AO info from AVEIN SAATY TAFOYA and contact info from Lisa Sawicke. 10/28/11 - Changed zip code from 85374. 5/13/11 UPDATED ENTITY NAME (WAS CLINICA ADELANTE, INC.); 2/28/11 ADDED BILL ADD12/19/2011 5:11 PM
ContactsPrimary ContactInsert  SAWICKE, LISA PURCHASING MANAGER 6235568860-135010/28/2011 12:03 PM
DetailsComments PublicInsert  10/28/11 - Changed zip code from 85374. 5/13/11 UPDATED ENTITY NAME (WAS CLINICA ADELANTE, INC.); 2/28/11 ADDED BILL ADD10/28/2011 12:03 PM
DetailsEntity SubnameUpdate TIDWELL FAMILY CARE CENTERADELANTE HEALTHCARE SURPRISE9/9/2011 11:02 AM
DetailsLast Recertification DateInsert   5/13/2011 3:44 PM
DetailsGrant NumberInsert  H80CS001405/13/2011 3:44 PM
Details340B IDInsert  CH09303E5/13/2011 3:44 PM
DetailsIs Authorizing Official EHB DataInsert   5/13/2011 3:44 PM
DatesLast Date That 340B Drugs PurchasedInsert   5/13/2011 3:44 PM
DetailsMedicare Provider NumberInsert   5/13/2011 3:44 PM
DetailsEntity NameInsert  ADELANTE HEALTH CARE, INC.5/13/2011 3:44 PM
DetailsProgram CodeInsert  CH5/13/2011 3:44 PM
DetailsEntity SubnameInsert  TIDWELL FAMILY CARE CENTER5/13/2011 3:44 PM
DatesParticipating Approval DateInsert  8/9/2005 12:00:00 AM5/13/2011 3:44 PM
DetailsStateInsert  Active5/13/2011 3:44 PM
DatesRegistration DateInsert  4/1/1999 12:00:00 AM5/13/2011 3:44 PM
DatesSigned By DateInsert   5/13/2011 3:44 PM
DatesStart DateInsert  4/1/1999 12:00:00 AM5/13/2011 3:44 PM
TerminationsTermination CommentsInsert   5/13/2011 3:44 PM
TerminationsTermination DateInsert   5/13/2011 3:44 PM
TerminationsTermination Effective DateInsert   5/13/2011 3:44 PM
TerminationsTermination ReasonInsert   5/13/2011 3:44 PM
DetailsComments PublicInsert  5/13/11 UPDATED ENTITY NAME (WAS CLINICA ADELANTE, INC.); 2/28/11 ADDED BILL ADD5/13/2011 3:44 PM