Covered Entity Details

CHC08229-05 FIRST NATIONS COMMUNITY HEALTH SOURCE INC (Active) - information as of 6/24/2025 12:05:12 AM

Main Details

Name

FIRST NATIONS COMMUNITY HEALTH SOURCE INC

Subdivision Name

Emerson Elementary School

Type

HRSA-Funded Health Center

Site ID

BPS-H80-021944

340B ID

CHC08229-05

Grant Number

H80CS08229

Additional Details

Current Program Status

Active

Registration Date

10/4/2019

Participating Start Date

1/1/2020

Participating Approval Date

12/9/2019

Last Recertification Date

2/11/2025

Contacts

Authorizing Official

First Nations Community HealthSource
Linda Son-Stone, CEO
(505) 262-6546

Primary Contact

First Nations Community HealthSource
Jane Anne Burak, CFO
(505) 262-2481

Addresses

Street Address

620 Georgia Street SE
Albuquerque, NM 87108-3806

Billing Address

First Nations Community HealthSource
5608 Zuni SE
Albuquerque, NM 87108

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NM	46912	1770009524

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC08229-00	Active	BPS-H80-005607	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	First Nations Community HealthSource	5608 Zuni Rd SE	Albuquerque	NM
CHC08229-01	Active	BPS-H80-012980	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	FNCH-Truman Health Center	625 Truman St NE	Albuquerque	NM
CHC08229-02	Active	BPS-H80-029406	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	Native American Community Academy High School	940 University Blvd SE	Albuquerque	NM
CHC08229-03	Active	BPS-H80-020876	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	Wilson Middle School	138 Cardenas Drive SE	Albuquerque	NM
CHC08229-04	Active	BPS-H80-020878	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	Native American Community Academy School Based Health Center	1000 Indian School Rd NW	Albuquerque	NM
CHC08229-05	Active	BPS-H80-021944	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	Emerson Elementary School	620 Georgia Street SE	Albuquerque	NM
CHC08229-06	Active	BPS-H80-020872	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	Grant Middle School	1111 Easterday Dr NE	Albuquerque	NM
CHC08229-07	Active	BPS-H80-029889	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	First Nations Community HealthSource Inc Central Avenue Health Center	7317 Central Ave NE	Albuquerque	NM
CHC08229-08	Terminated	BPS-H80-020946	FIRST NATIONS COMMUNITY HEALTH SOURCE INC	FNCH Outpatient Services	634 Manzano Street NE	Albuquerque	NM
CHC08229-09	Approved	BPS-H80-038517	First Nations Community Health Source Inc	FNCH Integrated Care Mobile Medical Van	5608 Zuni Rd SE	Albuquerque	NM
CHC08229-10	Approved	BPS-H80-033448	First Nations Community Health Source Inc	All Nations Wellness Center	6416 Zuni Rd SE	Albuquerque	NM
CHC08229-11	Approved	BPS-H80-036341	First Nations Community Health Source Inc	FNCH Vision Clinic	505 Madeira SE	Albuquerque	NM

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC08229-00	PHIL'S PHARMACY		5510 LOMAS N.E.	ALBUQUERQUE	NM	87110	01/01/2015	04/03/2017
CHC08229-01	PHIL'S PHARMACY		5510 LOMAS N.E.	ALBUQUERQUE	NM	87110	01/01/2015	06/22/2017
CHC08229-00	SMITH'S FOOD & DRUG CTRS	SMITH'S PHARMACY #496	3701 CONSTITUTION NE	ALBUQUERQUE	NM	87110	01/01/2015	04/03/2017
CHC08229-01	SMITH'S FOOD & DRUG CTRS	SMITH'S PHARMACY #496	3701 CONSTITUTION NE	ALBUQUERQUE	NM	87110	01/01/2015	06/22/2017
CHC08229-00	SMITHS FOOD & DRUG CTRS	DBA SMITH'S FOOD & DRUG #446	6001 LOMAS NE	ALBUQUERQUE	NM	87110	01/01/2015	04/03/2017
CHC08229-01	SMITHS FOOD & DRUG CTRS	DBA SMITH'S FOOD & DRUG #446	6001 LOMAS NE	ALBUQUERQUE	NM	87110	01/01/2015	06/22/2017
CHC08229-00	WAL-MART PHARMACY 10-0831	301 SAN MATEO BLV SE		ALBUQUERQUE	NM	87108	01/01/2015	09/03/2015
CHC08229-01	WAL-MART PHARMACY 10-0831	301 SAN MATEO BLV SE		ALBUQUERQUE	NM	87108	01/01/2015	09/07/2016
CHC08229-00	WALGREEN CO.	DBA: WALGREENS #11959	5201 CENTRAL AVE. NE	ALBUQUERQUE	NM	87108-1328	01/01/2015	09/03/2015
CHC08229-01	WALGREEN CO.	DBA: WALGREENS #11959	5201 CENTRAL AVE. NE	ALBUQUERQUE	NM	87108-1328	01/01/2015	09/07/2016
CHC08229-00	WALGREEN HASTINGS CO.	DBA: WALGREENS # 04649	3501 LOMAS BLVD. NE	ALBUQUERQUE	NM	87106	01/01/2015	09/03/2015
CHC08229-01	WALGREEN HASTINGS CO.	DBA: WALGREENS # 04649	3501 LOMAS BLVD. NE	ALBUQUERQUE	NM	87106	01/01/2015	09/07/2016

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 9:51:20 AM	2/11/2025 7:28:02 PM	2/11/2025 7:28 PM
Details	Last Recertification Date	Update	Recertification	2/6/2023 11:44:46 AM	1/30/2024 9:51:20 AM	1/30/2024 9:51 AM
Details	Last Recertification Date	Update	Recertification	2/9/2022 3:58:47 PM	2/6/2023 11:44:46 AM	2/6/2023 11:44 AM
Contacts	Primary Contact	Update	Group Change Request	Calabaza, Kevin Chief Financial Officer First Nations Community HealthSource 5052626069-5052626069	Burak, Jane Anne CFO First Nations Community HealthSource 5052622481	2/10/2022 8:01 AM
Details	Last Recertification Date	Update	Recertification	2/5/2021 1:50:10 PM	2/9/2022 3:58:47 PM	2/9/2022 3:58 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1770009524 ( )		2/5/2021 1:50 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770009524	2/5/2021 1:50 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	2/5/2021 1:50 PM
Contacts	Primary Contact	Update	Recertification	Paboucek, Leon Chief Financial Officer First Nations Community HealthSource 5052626069	Calabaza, Kevin Chief Financial Officer First Nations Community HealthSource 5052626069-5052626069	2/5/2021 1:50 PM
Details	Last Recertification Date	Update	Recertification	1/31/2020 5:57:09 PM	2/5/2021 1:50:10 PM	2/5/2021 1:50 PM
Details	Last Recertification Date	Update	Recertification		1/31/2020 5:57:09 PM	1/31/2020 5:57 PM
Details	State	Update		Approved	Active	1/1/2020 12:04 AM
Contacts	Signed By	Insert	New Registration		Son-Stone, Linda CEO First Nations Community HealthSource 5052626546	12/9/2019 12:17 AM
Details	340B ID	Update	New Registration		CHC08229-05	12/9/2019 12:17 AM
Dates	Participating Approval Date	Update	New Registration		12/9/2019 12:17:32 AM	12/9/2019 12:17 AM
Details	State	Update	New Registration	Pending	Approved	12/9/2019 12:17 AM
Dates	Signed By Date	Update	New Registration		10/4/2019 2:31:44 PM	12/9/2019 12:17 AM
Dates	Start Date	Update	New Registration		1/1/2020 12:00:00 AM	12/9/2019 12:17 AM
Addresses	Main Address	Insert	New Registration		620 Georgia Street SE Albuquerque, NM 87108-3806	10/4/2019 2:31 PM
Addresses	Billing Address	Insert	New Registration		First Nations Community HealthSource 5608 Zuni SE Albuquerque, NM 87108	10/4/2019 2:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/4/2019 2:31 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		46912	10/4/2019 2:31 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NM	10/4/2019 2:31 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1770009524	10/4/2019 2:31 PM
Contacts	Authorizing Official	Insert	New Registration		Son-Stone, Linda CEO First Nations Community HealthSource 5052626546	10/4/2019 2:31 PM
Contacts	Primary Contact	Insert	New Registration		Paboucek, Leon Chief Financial Officer First Nations Community HealthSource 5052626069	10/4/2019 2:31 PM
Details	Last Recertification Date	Insert	New Registration			10/4/2019 2:31 PM
Details	Grant Number	Insert	New Registration		H80CS08229	10/4/2019 2:31 PM
Details	340B ID	Insert	New Registration			10/4/2019 2:31 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/4/2019 2:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/4/2019 2:31 PM
Details	Medicare Provider Number	Insert	New Registration			10/4/2019 2:31 PM
Details	Entity Name	Insert	New Registration		FIRST NATIONS COMMUNITY HEALTH SOURCE INC	10/4/2019 2:31 PM
Details	Program Code	Insert	New Registration		CH	10/4/2019 2:31 PM
Details	Entity Subname	Insert	New Registration		Emerson Elementary School	10/4/2019 2:31 PM
Dates	Participating Approval Date	Insert	New Registration			10/4/2019 2:31 PM
Details	State	Insert	New Registration		Pending	10/4/2019 2:31 PM
Dates	Registration Date	Insert	New Registration		10/4/2019 2:31:41 PM	10/4/2019 2:31 PM
Dates	Signed By Date	Insert	New Registration			10/4/2019 2:31 PM
Dates	Start Date	Insert	New Registration			10/4/2019 2:31 PM
Terminations	Termination Comments	Insert	New Registration			10/4/2019 2:31 PM
Terminations	Termination Date	Insert	New Registration			10/4/2019 2:31 PM
Terminations	Termination Effective Date	Insert	New Registration			10/4/2019 2:31 PM
Terminations	Termination Reason	Insert	New Registration			10/4/2019 2:31 PM

340B Drug Pricing Program Database