| Details | Last Recertification Date | Update | Recertification | 2/22/2024 11:25:29 AM | 2/11/2025 1:38:49 PM | 2/11/2025 1:38 PM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2023 3:59:03 PM | 2/22/2024 11:25:29 AM | 2/22/2024 11:25 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Pease, Lore
CEO
El Centro Family Health
5057537218 | Deyapp, Darren
CEO
El Centro Family Health
5057537218 | 2/20/2024 12:51 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Vigil, Christine
Director of Pharmacy Services
El Centro Family Health
5057475944-6921188 | Vigil, Christine
Director of Pharmacy Services
El Centro Family Health
5057537395 | 10/5/2023 5:35 PM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2022 12:51:24 PM | 2/7/2023 3:59:03 PM | 2/7/2023 3:59 PM |
| Contacts | Primary Contact | Update | Recertification | Vigil, Christine
Director of Pharmacy Services
El Centro Family Health
5057475944 | Vigil, Christine
Director of Pharmacy Services
El Centro Family Health
5057475944-6921188 | 1/31/2023 4:23 PM |
| Details | Last Recertification Date | Update | Recertification | 2/24/2021 10:37:47 AM | 2/3/2022 12:51:24 PM | 2/3/2022 12:51 PM |
| Addresses | Main Address | Update | Recertification |
1058 La Loma Rd
Anton Chico, NM 87711 |
1044 La Loma Rd
Anton Chico, NM 87711 | 2/24/2021 10:37 AM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2020 4:36:15 PM | 2/24/2021 10:37:47 AM | 2/24/2021 10:37 AM |
| Details | Last Recertification Date | Update | Recertification | 2/6/2019 10:31:58 AM | 2/5/2020 4:36:15 PM | 2/5/2020 4:36 PM |
| Details | Last Recertification Date | Update | Recertification | 3/5/2018 6:35:16 PM | 2/6/2019 10:31:58 AM | 2/6/2019 10:31 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2017 12:00:00 AM | 3/5/2018 6:35:16 PM | 3/5/2018 6:35 PM |
| Contacts | Authorizing Official | Update | New Registration | Pease, Lore
CEO
5057537218 | Pease, Lore
CEO
El Centro Family Health
5057537218 | 10/3/2017 2:24 PM |
| Contacts | Primary Contact | Update | | Vigil, Christine
Director of Pharmacy Services
5057475944 | Vigil, Christine
Director of Pharmacy Services
El Centro Family Health
5057475944 | 10/3/2017 2:10 PM |
| Contacts | Authorizing Official | Insert | | | Pease, Lore
CEO
5057537218 | 5/1/2017 5:58 PM |
| Contacts | Primary Contact | Insert | | | Vigil, Christine
Director of Pharmacy Services
5057475944 | 5/1/2017 5:58 PM |
| Addresses | Main Address | Insert | | |
1058 La Loma Rd
Anton Chico, NM 87711 | 1/31/2017 5:48 PM |
| Details | Last Recertification Date | Update | | 3/8/2016 12:00:00 AM | 1/31/2017 12:00:00 AM | 1/31/2017 5:48 PM |
| Addresses | Billing Address | Insert | | | EL CENTRO FAMILY HEALTH
PO BOX 158
ESPANOLA, NM 87532 | 3/8/2016 9:21 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | 3/1/2011 12:00:00 AM | | 3/8/2016 9:21 AM |
| Details | State | Update | | Terminated | Active | 3/8/2016 9:21 AM |
| Terminations | Termination Comments | Update | | The building is utilized for Administrative Staff, not as patient care clinic | | 3/8/2016 9:21 AM |
| Terminations | Termination Date | Update | | 4/1/2016 12:00:00 AM | | 3/8/2016 9:21 AM |
| Terminations | Termination Effective Date | Update | | 3/1/2016 12:00:00 AM | | 3/8/2016 9:21 AM |
| Terminations | Termination Reason | Update | | Site closure | | 3/8/2016 9:21 AM |
| Details | Last Recertification Date | Update | | 2/3/2015 12:00:00 AM | 3/8/2016 12:00:00 AM | 3/8/2016 7:59 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 3/1/2011 12:00:00 AM | 3/8/2016 7:59 AM |
| Details | State | Update | | Active | Terminated | 3/8/2016 7:59 AM |
| Terminations | Termination Comments | Update | | | The building is utilized for Administrative Staff, not as patient care clinic | 3/8/2016 7:59 AM |
| Terminations | Termination Date | Update | | | 4/1/2016 12:00:00 AM | 3/8/2016 7:59 AM |
| Terminations | Termination Effective Date | Update | | | 3/1/2016 12:00:00 AM | 3/8/2016 7:59 AM |
| Terminations | Termination Reason | Update | | | Site closure | 3/8/2016 7:59 AM |
| Details | Last Recertification Date | Update | | 3/18/2014 12:00:00 AM | 2/3/2015 12:00:00 AM | 2/3/2015 1:48 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/18/2014 12:00:00 AM | 3/18/2014 4:39 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/15/2013 12:15 PM |
| Details | Last Recertification Date | Insert | | | | 7/14/2011 3:23 PM |
| Details | Grant Number | Insert | | | H80CS00605 | 7/14/2011 3:23 PM |
| Details | 340B ID | Insert | | | CH06033L | 7/14/2011 3:23 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/14/2011 3:23 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/14/2011 3:23 PM |
| Details | Medicare Provider Number | Insert | | | | 7/14/2011 3:23 PM |
| Details | Entity Name | Insert | | | EL CENTRO FAMILY HEALTH | 7/14/2011 3:23 PM |
| Details | Program Code | Insert | | | CH | 7/14/2011 3:23 PM |
| Details | Entity Subname | Insert | | | LA LOMA CLINIC | 7/14/2011 3:23 PM |
| Dates | Participating Approval Date | Insert | | | 7/14/2011 12:00:00 AM | 7/14/2011 3:23 PM |
| Details | State | Insert | | | Active | 7/14/2011 3:23 PM |
| Dates | Registration Date | Insert | | | 8/1/1993 12:00:00 AM | 7/14/2011 3:23 PM |
| Dates | Signed By Date | Insert | | | | 7/14/2011 3:23 PM |
| Dates | Start Date | Insert | | | 8/1/1993 12:00:00 AM | 7/14/2011 3:23 PM |
| Terminations | Termination Comments | Insert | | | | 7/14/2011 3:23 PM |
| Terminations | Termination Date | Insert | | | | 7/14/2011 3:23 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/14/2011 3:23 PM |
| Terminations | Termination Reason | Insert | | | | 7/14/2011 3:23 PM |
| Details | Comments Public | Insert | | | 3/23/07 - UPDATED ENTITY NAME (WAS HEALTH CENTERS OF NORTHERN NM) 7/14/11 - CHANGE PHYSICAL ADDRESS FROM PO BOX I, 1/2 MILES SOUTH OF HWY 119 AND ADDED BILL ADDRESS. | 7/14/2011 3:23 PM |
| Details | Comments Public | Insert | | | 3/23/07 - UPDATED ENTITY NAME (WAS HEALTH CENTERS OF NORTHERN NM)
7/14/11 - CHANGE PHYSICAL ADDRESS FROM PO BOX I, 1/2 MILES SOUTH OF HWY 119 AND ADDED BILL ADDRESS. | 7/14/2011 3:23 PM |