340B Drug Pricing Program Database


CH09130A CANYONLANDS COMMUNITY HEALTH CARE (Terminated) - information as of 4/25/2025 7:26:12 PM

Main Details
CANYONLANDS COMMUNITY HEALTH CARE
KAIBETO BOARDING SCHOOL CLINIC
HRSA-Funded Health Center
BPS-H80-002011
CH09130A
H80CS00448


Additional Details
Terminated
7/1/2001
7/1/2001
5/14/2004
2/29/2016

10/1/2016
Site closure

Contacts

Canyonlands Community Health Care
Christopher Hansen, CEO
(928) 645-6600

Mari Reed, Director of Operations & Billing
(928) 645-9675 Ext: 5521

Addresses

RT 98 DORM STE 4
KAIBETO, AZ 86053-0000

CANYONLANDS COMMUNITY HEALTH CARE
PO BOX 1625
Page, AZ 86040


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
5/14/04 - CORRECTED ENTITY NAME, 8/29/06 - ADDED BILLING ADDRESS08/29/2006
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH091300ActiveBPS-H80-004454CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Lake Powell467 VISTA AVENUE PAGEAZ
CH09130ATerminatedBPS-H80-002011CANYONLANDS COMMUNITY HEALTH CAREKAIBETO BOARDING SCHOOL CLINICRT 98 DORM STE 4 KAIBETOAZ
CH09130BActiveBPS-H80-011483CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - ChilchinbetoChilchinbeto Chapter House Complex ChilchinbetoAZ
CH09130DActiveBPS-H80-009239CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Beaver Dam3272 E RIO VIRGIN RD LITTLEFIELDAZ
CH09130GActiveBPS-H80-010891CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Safford2016 W 16th St SaffordAZ
CH09130HActiveBPS-H80-007424CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Clifton10-A S. WARD CANYON ROAD CLIFTONAZ
CH09130IActiveBPS-H80-001987CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Duncan227 Main St DuncanAZ
CH09130JActiveBPS-H80-003516CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Urgent Care440 NORTH NAVAJO PAGEAZ
CH09130KActiveBPS-H80-011479CANYONLANDS COMMUNITY HEALTH CARECanyonlands Healthcare - Globe5860 S. Hospital Dr., Suite 102 GlobeAZ
CH09130LActiveBPS-H80-019571Canyonlands Community Health CareCanyonlands Healthcare - Safford Integrated1615 South 1st Avenue SaffordAZ
CH09130MTerminatedBPS-H80-019547Canyonlands Community Health CareCanyonlands Healthcare - Globe Integrated111 West Blake Street GlobeAZ
CH09130NActiveBPS-H80-032623Canyonlands Community Health CareCanyonlands Healthcare - Mobile Clinic827 Vista Ave. PageAZ
CH09130PActiveBPS-H80-032624Canyonlands Community Health CareCanyonlands Healthcare - Mesquite210 N Sandhill Blvd MesquiteNV
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH091300ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280901/01/2025  
CH091300AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291104/01/2019 01/14/2022
CH091300AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503404/01/2019 01/14/2022
CH091300CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2022  
CH091300CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2022  
CH091300CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2022  
CH091300CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2022  
CH091300CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2022  
CH091300CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2022  
CH091300CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2022  
CH091300CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/01/2022  
CH091300CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/01/2022  
CH091300CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2022  
CH091300COBRE VALLEY COMMUNITY HOSP5880 S HOSPITAL DR OUTPATIENT PHARMACY
GLOBEAZ85501-944704/01/2016 11/16/2017
CH091300CORAM ALTERNATE SITE SERVICES, INCDBA CORAM CVS/SPECIALTY INFUSION SERVICE 12310 WORLD TRADE DRIVE
SUITE 100 		SAN DIEGOCA9212804/01/2025  
CH091300CORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 4310 EAST COTTON CENTER BLVD
SUITE 110 		PHOENIXAZ85040-885701/01/2025  
CH091300CORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 2345 WATERS DRIVE
MENDOTA HEIGHTSMN5512004/01/2025  
CH091300CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2022  
CH091300CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2022  
CH091300CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2022  
CH091300CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/01/2022  
CH091300DSW ENTERPRISES INCDBA WALTON DRUG 1520 W THATCHER BLVD
SAFFORDAZ85546-330910/01/2022  
CH091300GERMAN DOBSON CVS, L.L.C.DBA CVS/PHARMACY #11144 100 NORTH BROAD ST.
GLOBEAZ8550101/01/2020  
CH091300M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312604/01/2019 01/14/2022
CH091300OPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502901/01/2022  
CH091300OPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520410/01/2024  
CH091300OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713001/01/2022  
CH091300OPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824901/01/2022  
CH091300OPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140101/01/2022  
CH091300OPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508501/01/2022  
CH091300OPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660801/01/2022 05/27/2022
CH091300OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983801/01/2022  
CH091300PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310104/01/2019 01/14/2022
CH091300PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2022  
CH091300PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2022  
CH091300PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681307/01/2022  
CH091300PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2022  
CH091300SAFEWAY INCSAFEWAY PHARMACY #0249 P.O.BOX 1346
650 ELM STREET 		PAGEAZ8604001/13/2011  
CH091300SAFEWAY INCSAFEWAY PHARMACY #2648 2125 N HIGHWAY 70
THATCHERAZ8555201/01/2015  
CH09130JSAFEWAY INCSAFEWAY PHARMACY #0249 P.O.BOX 1346
650 ELM STREET 		PAGEAZ8604007/02/2010  
CH09130GSAFEWAY INCSAFEWAY PHARMACY #2648 2125 N HIGHWAY 70
THATCHERAZ8555207/21/2010  
CH091300SMITH FOOD & DRUG CENTERS INC. DBA SMITH'S PHARMACY #342350 N SANDHILL BLVD
MESQUITENV8902701/01/2015  
CH09130DSMITH FOOD & DRUG CENTERS INC. DBA SMITH'S PHARMACY #342350 N SANDHILL BLVD
MESQUITENV8902707/12/2010  
CH091300SMITH'S FOOD AND DRUG CTR INCDBA FRY'S FOOD AND DRUG #109 2115 U.S. HWY 60
STE 200 		MIAMIAZ8553901/01/2020  
CH091300WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/01/2018  
CH091300WAL-MART PHARMACY 10-1149755 SO 20TH AVE
SAFFORDAZ8554601/01/2018 11/02/2017
CH091300WAL-MART PHARMACY 10-1149755 SO 20TH AVE
SAFFORDAZ8554601/01/2018  
CH091300WAL-MART PHARMACY 10-1334100 SOUTH RAGUS ROAD
CLAYPOOLAZ8553201/01/2018 11/02/2017
CH091300WAL-MART PHARMACY 10-1334100 SOUTH RAGUS ROAD
CLAYPOOLAZ8553201/01/2018  
CH091300WAL-MART PHARMACY 10-14421017 WEST HAUL ROAD
PAGEAZ8604001/01/2018 11/02/2017
CH091300WAL-MART PHARMACY 10-14421017 WEST HAUL ROAD
PAGEAZ8604001/01/2018  
CH091300WAL-MART PHARMACY 10-38471120 WEST PIONEER BLVD
MESQUITENV8902701/01/2018 11/02/2017
CH091300WAL-MART PHARMACY 10-38471120 WEST PIONEER BLVD
MESQUITENV8902701/01/2018  
CH091300WAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281901/01/2018 11/02/2017
CH091300WAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281901/01/2018 03/22/2022
CH091300WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/01/2018  
CH091300WALGREEN ARIZONA DRUG CO.DBA: WALGREENS # 02429 1995 W THATCHER BLVD
SAFFORDAZ85546-331604/01/2014  
CH091300WALGREEN ARIZONA DRUG CO.WALGREENS CENTRAL FILL #21372 120 N 83RD AVE
STE 200 		TOLLESONAZ8535310/01/2021  
CH091300WALGREEN CO.DBA: WALGREENS #12646 329 N. SANDHILL BLVD
MESQUITENV89027-472904/01/2014  
CH091300WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528404/01/2014 08/17/2015
CH091300WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/01/2022  
CH091300WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/01/2022  
CH091300WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/01/2022  
CH091300WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/01/2023  
CH091300Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616807/01/2024  
CH091300WALTON DRUG OF MORENCIWALTON DRUG 408 BURRO ALLEY
MORENCIAZ8554010/01/2022  
CH091300WESTERN PHARMACY GROUP LLCDBA COMMUNITY MEDICAL CENTER PHARMACY 610 GATEWAY CENTER WAY
SUITES A--E 		SAN DIEGOCA9210204/01/2019 01/14/2022
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdate Hansen, Christopher CEO 9286456600Hansen, Christopher CEO Canyonlands Community Health Care 928645660010/18/2017 12:54 PM
ContactsAuthorizing OfficialUpdate LATHAM, ELIZABETH CEO 9286459675-5507Hansen, Christopher CEO 92864566006/19/2017 11:51 AM
AddressesMain AddressInsert   RT 98 DORM STE 4 KAIBETO, AZ 86053-00009/1/2016 4:47 PM
AddressesBilling AddressInsert  CANYONLANDS COMMUNITY HEALTH CARE PO BOX 1625 Page, AZ 860409/1/2016 4:47 PM
ContactsPrimary ContactInsert  Reed, Mari Director of Operations & Billing 9286459675-55219/1/2016 4:47 PM
DatesLast Date That 340B Drugs PurchasedUpdate  8/31/2016 12:00:00 AM9/1/2016 4:47 PM
DetailsStateUpdate ActiveTerminated9/1/2016 4:47 PM
TerminationsTermination DateUpdate  10/1/2016 12:00:00 AM9/1/2016 4:47 PM
TerminationsTermination Effective DateUpdate  8/31/2016 12:00:00 AM9/1/2016 4:47 PM
TerminationsTermination ReasonUpdate  Site closure9/1/2016 4:47 PM
DetailsLast Recertification DateUpdate 3/5/2015 12:00:00 AM2/29/2016 12:00:00 AM2/29/2016 1:56 PM
ContactsAuthorizing OfficialUpdate LATHAM, ELIZABETH CEO 9286459675-5507LATHAM, ELIZABETH CEO 9286459675-55078/17/2015 2:57 PM
DetailsLast Recertification DateUpdate 3/14/2014 12:00:00 AM3/5/2015 12:00:00 AM3/5/2015 3:13 PM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/14/2014 12:00:00 AM3/14/2014 5:49 AM
DetailsEntity SubnameUpdate KAIBETO CLINICKAIBETO BOARDING SCHOOL CLINIC3/14/2014 5:49 AM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM3/26/2013 10:38 AM
ContactsAuthorizing OfficialInsert  LATHAM, ELIZABETH CEO 9286459675-550712/19/2011 5:13 PM
DetailsLast Recertification DateInsert   8/29/2006 3:23 PM
DetailsGrant NumberInsert  H80CS004488/29/2006 3:23 PM
Details340B IDInsert  CH09130A8/29/2006 3:23 PM
DetailsIs Authorizing Official EHB DataInsert   8/29/2006 3:23 PM
DatesLast Date That 340B Drugs PurchasedInsert   8/29/2006 3:23 PM
DetailsMedicare Provider NumberInsert   8/29/2006 3:23 PM
DetailsEntity NameInsert  CANYONLANDS COMMUNITY HEALTH CARE8/29/2006 3:23 PM
DetailsProgram CodeInsert  CH8/29/2006 3:23 PM
DetailsEntity SubnameInsert  KAIBETO CLINIC8/29/2006 3:23 PM
DatesParticipating Approval DateInsert  5/14/2004 12:00:00 AM8/29/2006 3:23 PM
DetailsStateInsert  Active8/29/2006 3:23 PM
DatesRegistration DateInsert  7/1/2001 12:00:00 AM8/29/2006 3:23 PM
DatesSigned By DateInsert   8/29/2006 3:23 PM
DatesStart DateInsert  7/1/2001 12:00:00 AM8/29/2006 3:23 PM
TerminationsTermination CommentsInsert   8/29/2006 3:23 PM
TerminationsTermination DateInsert   8/29/2006 3:23 PM
TerminationsTermination Effective DateInsert   8/29/2006 3:23 PM
TerminationsTermination ReasonInsert   8/29/2006 3:23 PM
DetailsComments PublicInsert  5/14/04 - CORRECTED ENTITY NAME, 8/29/06 - ADDED BILLING ADDRESS8/29/2006 3:23 PM