Covered Entity Details

CH08003N VALLEY-WIDE HEALTH SYSTEMS, INC. (Active) - information as of 5/30/2025 6:46:48 PM

Main Details

Name

VALLEY-WIDE HEALTH SYSTEMS, INC.

Subdivision Name

Rocky Ford Clinic or Rocky Ford Dental Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-000897

340B ID

CH08003N

Grant Number

H80CS00134

Additional Details

Current Program Status

Active

Registration Date

7/1/2001

Participating Start Date

7/1/2001

Participating Approval Date

5/13/2005

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Valley-Wide Health Systems
Jania Arnoldi, President/CEO
(719) 587-1000

Primary Contact

Valley-Wide Health Systems, Inc.
Justin Hanel, Director of Pharmacy
(719) 589-3633

Addresses

Street Address

903 S 12th St
Rocky Ford, CO 81067

Billing Address

Valley-Wide Health Systems, Inc.
128 Market St
Alamosa, CO 81101

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

Comments

Comment	Last Updated On
11/23/11 - Modified sub division name to include dental clinic. 3/16/09 ADDR CHANGE (WAS 405 N. 12TH STREET)2/26/07 - UPDATED ENTITY NAME (WAS VALLEY WIDE HEALTH SERVICES)	11/23/2011
3/16/09 ADDR CHANGE (WAS 405 N. 12TH STREET)2/26/07 - UPDATED ENTITY NAME (WAS VALLEY WIDE HEALTH SERVICES)	03/16/2009

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
CO	04280270	1104813682,1790998953,1215139613
NM		1104813682,1215139613,1790998953

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
Contract Detail	HARRIS PHARMACY	PHARMACY SERVICES INC	309 N MAIN ST PO BOX 546	ROCKY FORD	CO	81067-1253	10/12/2023	01/01/2024			01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH080030	Active	BPS-H80-001418	VALLEY-WIDE HEALTH SYSTEMS, INC.	Alamosa Family Medical Center, Valley Wide Pharmacy, or Anti-Coagulation Clinic	1710 1st St	Alamosa	CO
CH08003AA	Active	BPS-H80-031019	VALLEY-WIDE HEALTH SYSTEMS, INC.	Valley-Wide Buena Vista	707 US Highway 24 N	Buena Vista	CO
CH08003AB	Active	BPS-H80-031179	VALLEY-WIDE HEALTH SYSTEMS, INC.	The Pulse School-Based Health Center	1215 Main St Ste B	Canon City	CO
CH08003AC	Active	BPS-H80-035147	VALLEY-WIDE HEALTH SYSTEMS, INC.	Valley-Wide Integrated Care Clinic- La Junta	711 Barnes Ave	La Junta	CO
CH08003AD	Active	BPS-H80-036444	VALLEY-WIDE HEALTH SYSTEMS, INC.	Valley-Wide Counseling & Support Center - Rocky Ford	404 N Main St	Rocky Ford	CO
CH08003AE	Active	BPS-H80-036445	VALLEY-WIDE HEALTH SYSTEMS, INC.	Valley-Wide Regional Assessment Center- La Junta	721 Barnes Ave	La Junta	CO
CH08003AF	Active	BPS-H80-038159	VALLEY-WIDE HEALTH SYSTEMS, INC.	Valley-Wide MERV Mobile Unit	925 2nd Ave	Monte Vista	CO
CH08003AG	Active	BPS-H80-038327	VALLEY-WIDE HEALTH SYSTEMS, INC.	Mini MERV	602 Hunt Ave	Alamosa	CO
CH08003AH	Approved	BPS-H80-039902	VALLEY-WIDE HEALTH SYSTEMS	Rock Creek Family Medicine	77 Adcock Dr	Alamosa	CO
CH08003B	Active	BPS-H80-000877	VALLEY-WIDE HEALTH SYSTEMS, INC.	Cesar E. Chavez Medical Center	186 HURT ST	CENTER	CO
CH08003C	Active	BPS-H80-003074	VALLEY-WIDE HEALTH SYSTEMS, INC.	GUADALUPE HEALTH CENTER	10TH STREET AND DAHLIA	ANTONITO	CO
CH08003D	Active	BPS-H80-007581	VALLEY-WIDE HEALTH SYSTEMS, INC.	San Luis Health Center, Ernesto Pacheco Dental Clinic, or San Luis Physical Therapy and Rehabilitation	233 Main Street STE B	San Luis	CO
CH08003E	Terminated	BPS-H80-001418	VALLEY WIDE HEALTH SYSTEMS, INC.	Alamosa Family Medical Center, VWHS Pharmacy, or Anti-Coagulation Clinic	1710 1st St	Alamosa	CO
CH08003F	Active	BPS-H80-010152	VALLEY-WIDE HEALTH SYSTEMS, INC.	Edward M. Kennedy Health Clinic	925 2nd Ave	Monte Vista	CO
CH08003H	Active	BPS-H80-003646	VALLEY-WIDE HEALTH SYSTEMS, INC.	MOFFAT FAMILY HEALTH CENTER	545 MOFFAT WAY	MOFFAT	CO
CH08003I	Active	BPS-H80-001182	VALLEY-WIDE HEALTH SYSTEMS, INC.	Valley-Wide Health Systems, Inc., Administrative Services Building, Alamosa Dental Clinic, Counseling and Support Center	128 Market St	Alamosa	CO
CH08003K	Active	BPS-H80-001500	VALLEY-WIDE HEALTH SYSTEMS, INC.	Sierra Blanca Medical Center or Alamosa Physical Therapy and Rehabilitation	106 BLANCA AVE STE 300	ALAMOSA	CO
CH08003M	Active	BPS-H80-031533	VALLEY-WIDE HEALTH SYSTEMS, INC.	CENTER DENTAL CLINIC	135 E 6th St	CENTER	CO
CH08003N	Active	BPS-H80-000897	VALLEY-WIDE HEALTH SYSTEMS, INC.	Rocky Ford Clinic or Rocky Ford Dental Clinic	903 S 12th St	Rocky Ford	CO
CH08003P	Active	BPS-H80-004243	VALLEY-WIDE HEALTH SYSTEMS, INC.	Las Animas Clinic and Las Animas Dental Clinic	245 Vine Ave	Las Animas	CO
CH08003Q	Active	BPS-H80-012270	VALLEY-WIDE HEALTH SYSTEMS, INC.	LA JUNTA CLINIC	1012 Belmont Ave.	La Junta	CO
CH08003R	Terminated	BPS-H80-005434	VALLEY WIDE HEALTH SYSTEMS, INC.	FREMONT FAMILY MEDICAL CENTER	602 Yale Place	Canon City	CO
CH08003T	Active	BPS-H80-007659	VALLEY-WIDE HEALTH SYSTEMS, INC.	Convenient Care Community Clinic	1131 Main St	Alamosa	CO
CH08003U	Active	BPS-H80-003930	VALLEY-WIDE HEALTH SYSTEMS, INC.	LA JARA DENTAL CLINIC	421 WALNUT ST	LA JARA	CO
CH08003V	Terminated	BPS-H80-006277	VALLEY-WIDE HEALTH SYSTEMS, INC.	VWHS Mobile Health Unit	106 Blanca Avenue, Suite 300	ALAMOSA	CO
CH08003W	Terminated	BPS-H80-017356	VALLEY WIDE HEALTH SYSTEMS, INC.	Valley-Wide Health Systems, Inc. - Carson Building	204 Carson Avenue	Alamosa	CO
CH08003X	Active	BPS-H80-027682	VALLEY-WIDE HEALTH SYSTEMS, INC.	Valley-Wide Canon City	121 N 6th St	Canon City	CO
CH08003Y	Terminated	BPS-H80-020947	VALLEY WIDE HEALTH SYSTEMS, INC.	Alamosa South Health Center	8745 County Road 9 South. Building C	Alamosa	CO
CH08003Z	Active	BPS-H80-028367	VALLEY-WIDE HEALTH SYSTEMS, INC.	Valley-Wide Ordway	319 Main St	Ordway	CO

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH080030	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2023	03/18/2024
CH080030	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2023	03/18/2024
CH080030	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2023	03/18/2024
CH080030	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2023	03/18/2024
CH080030	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2023	03/18/2024
CH080030	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2023	09/22/2023
CH080030	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2023	03/18/2024
CH080030	ALAMOSA PHARMACY	POLITO E MARTINEZ JR, RPH	108 BLANCA AVENUE SAN LUIS VALLEY REG MEDICAL CTR	ALAMOSA	CO	81101	10/01/2012	06/21/2018
CH080030	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	07/01/2023	04/13/2024
CH080030	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	07/01/2023	04/13/2024
CH080030	BUENA VISTA DRUG (DBA)	RXPLUS LIMITED	403 HWY 24 S PO BOX 1670	BUENA VISTA	CO	81211	04/01/2020	04/30/2021
CH080030	CITY MARKET PHARMACY #17	1703 FREMONT		CANON CITY	CO	81212	07/01/2015	11/15/2024
CH08003AB	CITY MARKET PHARMACY #17	1703 FREMONT		CANON CITY	CO	81212	01/01/2024	11/15/2024
CH080030	CITY MARKET PHARMACY #22	131 MARKET ST		ALAMOSA	CO	81101	07/01/2015
CH08003T	CITY MARKET PHARMACY #22	131 MARKET ST		ALAMOSA	CO	81101	01/01/2024
CH080030	CITY MARKET PHARMACY #437	438 S HWY 24	P.O. BOX 2024	BUENA VISTA	CO	81211-2024	04/01/2020	06/06/2021
CH080030	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2023	03/18/2024
CH080030	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2023	03/18/2024
CH080030	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2023	03/18/2024
CH080030	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2023	03/18/2024
CH080030	GENOA HEALTHCARE LLC	8745 COUNTY ROAD 9 S STE 152		ALAMOSA	CO	81101	10/01/2022
CH08003I	GENOA HEALTHCARE LLC	8745 COUNTY ROAD 9 S STE 152		ALAMOSA	CO	81101	01/01/2024
CH080030	HARRIS PHARMACY	PHARMACY SERVICES INC	309 N MAIN ST PO BOX 546	ROCKY FORD	CO	81067-1253	08/20/2012
CH08003N	HARRIS PHARMACY	PHARMACY SERVICES INC	309 N MAIN ST PO BOX 546	ROCKY FORD	CO	81067-1253	01/01/2024
CH080030	JACK'S MARKET PHARMACY	222 SOLAR AVE.		MONTE VISTA	CO	81144	01/01/2024	12/01/2023
CH08003F	JACK'S MARKET PHARMACY	222 SOLAR AVE.		MONTE VISTA	CO	81144	01/01/2024	12/01/2023
CH080030	LA JARA PHARMACEUTICAL CENTER	LA JARA PHARMACY	412 MAIN STREET P.O. BOX 609	LA JARA	CO	81140	10/01/2012	06/21/2018
CH080030	OPERA HOUSE PHARMACY	223 COLORADO AVE		LA JUNTA	CO	81050	10/01/2013	04/30/2024
CH08003AD	OPERA HOUSE PHARMACY	223 COLORADO AVE		LA JUNTA	CO	81050	01/01/2024	04/30/2024
CH080030	ORDWAY PHARMACY	PDO VAL-U-MED PHARMACY	228 MAIN ST	ORDWAY	CO	81063	08/20/2012
CH08003Z	ORDWAY PHARMACY	PDO VAL-U-MED PHARMACY	228 MAIN ST	ORDWAY	CO	81063	01/01/2024
CH08003F	PURGATORY PHARMACEUTICAL SERVICES LLC	DBA JACK'S MARKET PHARMACY	222 SOLAR AVE	MONTE VISTA	CO	81144	01/16/2025
CH080030	PURGATORY PHARMACEUTICAL SERVICES LLC	DBA JACK'S MARKET PHARMACY	222 SOLAR AVE	MONTE VISTA	CO	81144	01/16/2025
CH080030	REAM'S PALACE DRUG INC	601 MAIN ST	BOX 159	CANON CITY	CO	81212-3736	03/23/2012
CH08003AA	REAM'S PALACE DRUG INC	601 MAIN ST	BOX 159	CANON CITY	CO	81212-3736	01/01/2024
CH080030	SAFEWAY INC	SAFEWAY PHARMACY #1681	1301 MAIN STREET	ALAMOSA	CO	81101	12/16/2011
CH080030	SAFEWAY INC	SAFEWAY PHARMACY #3723	315 W 2ND STREET	LA JUNTA	CO	81050	02/15/2012
CH080030	SAFEWAY INC	SAFEWAY PHARMACY #3728	1414 MAIN STREET	CANON CITY	CO	81212	06/06/2012
CH08003K	SAFEWAY INC	SAFEWAY PHARMACY #1681	1301 MAIN STREET	ALAMOSA	CO	81101	01/01/2024
CH08003Q	SAFEWAY INC	SAFEWAY PHARMACY #3723	315 W 2ND STREET	LA JUNTA	CO	81050	01/01/2024
CH08003B	SAFEWAY INC	SAFEWAY PHARMACY #3728	1414 MAIN STREET	CANON CITY	CO	81212	01/01/2024
CH080030	SHAVANO PHARMACY LLC	415 US HIGHWAY 24 N		BUENA VISTA	CO	81211-9651	04/01/2021	12/27/2021
CH080030	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	07/01/2019
CH08003D	THE KROGER CO., KS 113	1220 S. LIPAN STREET		DENVER	CO	80223	01/01/2024
CH080030	VAL-U-MED	PHARMACY SERVICES INCORPORATED	159 BENT AVE	LAS ANIMAS	CO	81054	08/20/2012
CH08003P	VAL-U-MED	PHARMACY SERVICES INCORPORATED	159 BENT AVE	LAS ANIMAS	CO	81054	01/01/2024
CH080030	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2018
CH080030	WAL-MART PHARMACY 10-0869	3333 CLARK STREET		ALAMOSA	CO	81101	10/01/2018
CH08003V	WAL-MART PHARMACY 10-0869	3333 CLARK STREET		ALAMOSA	CO	81101	01/01/2024	10/01/2024
CH08003AF	WAL-MART PHARMACY 10-0869	3333 CLARK STREET		ALAMOSA	CO	81101	07/01/2024
CH080030	WAL-MART PHARMACY 10-1019	3105 HWY 50 EAST		CANON CITY	CO	81212	10/01/2018
CH08003X	WAL-MART PHARMACY 10-1019	3105 HWY 50 EAST		CANON CITY	CO	81212	07/01/2024
CH080030	WAL-MART PHARMACY 10-1384	6 CONLEY ROAD		LA JUNTA	CO	81050	10/01/2018
CH08003AC	WAL-MART PHARMACY 10-1384	6 CONLEY ROAD		LA JUNTA	CO	81050	01/01/2024
CH080030	WAL-MART PHARMACY 10-2672	1432 EAST OLIVE		LAMAR	CO	81052	10/01/2018	12/14/2018
CH080030	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2018
CH080030	WALGREEN CO.	DBA: WALGREENS # 09393	1609 FREMONT DR	CANON CITY	CO	81212-2403	09/20/2011
CH080030	WALGREEN CO.	DBA: WALGREENS # 09912	1203 MAIN ST	ALAMOSA	CO	81101-2395	09/20/2011
CH08003C	WALGREEN CO.	DBA: WALGREENS # 09393	1609 FREMONT DR	CANON CITY	CO	81212-2403	01/01/2024
CH08003H	WALGREEN CO.	DBA: WALGREENS # 09912	1203 MAIN ST	ALAMOSA	CO	81101-2395	01/01/2024
CH080030	Walgreens #21397	Walgreens Central Fill #21397	5675 Pecos St. Suite 100	Denver	CO	80221-6655	01/01/2023
CH08003AE	Walgreens #21397	Walgreens Central Fill #21397	5675 Pecos St. Suite 100	Denver	CO	80221-6655	01/01/2024
CH080030	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	10/01/2018	08/06/2018
CH080030	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2018	08/06/2018
CH080030	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2023
CH080030	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/3/2024 3:56:45 PM	2/12/2025 12:13:34 PM	2/12/2025 12:13 PM
Details	Entity Name	Update	Group Change Request	VALLEY WIDE HEALTH SYSTEMS, INC.	VALLEY-WIDE HEALTH SYSTEMS, INC.	5/28/2024 6:37 PM
Contacts	Primary Contact	Update	Profile Change Request	Hanel, Justin Pharmacist Valley-Wide Health Systems, Inc. 7195893633	Hanel, Justin Director of Pharmacy Valley-Wide Health Systems, Inc. 7195893633	4/26/2024 11:08 AM
Details	Last Recertification Date	Update	Recertification	1/30/2023 10:12:53 AM	2/3/2024 3:56:45 PM	2/3/2024 3:56 PM
Details	Last Recertification Date	Update	Recertification	2/8/2022 10:58:01 AM	1/30/2023 10:12:53 AM	1/30/2023 10:12 AM
Addresses	Main Address	Update	Change Request	903 S 12th St Rocky Ford, CO 81067-2127	903 S 12th St Rocky Ford, CO 81067	9/6/2022 6:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1104813682	9/6/2022 6:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		NM	9/6/2022 6:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1215139613	9/6/2022 6:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		NM	9/6/2022 6:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790998953	9/6/2022 6:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		NM	9/6/2022 6:47 AM
Addresses	Billing Address	Insert	Group Change Request		Valley-Wide Health Systems, Inc. 128 Market St Alamosa, CO 81101	7/28/2022 10:22 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1215139613	7/28/2022 10:22 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		CO	7/28/2022 10:22 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 12:00:20 PM	2/8/2022 10:58:01 AM	2/8/2022 10:58 AM
Medicaid Billing	NPI: State	Update	Recertification		CO	2/4/2021 12:00 PM
Medicaid Billing	NPI: State	Update	Recertification		CO	2/4/2021 12:00 PM
Details	Last Recertification Date	Update	Recertification	1/28/2020 10:12:21 AM	2/4/2021 12:00:20 PM	2/4/2021 12:00 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1790998953	4/16/2020 11:50 AM
Details	Last Recertification Date	Update	Recertification	2/5/2019 7:55:44 PM	1/28/2020 10:12:21 AM	1/28/2020 10:12 AM
Contacts	Authorizing Official	Update	Change Request	DARRICADES, JEANNE PRESIDENT/CEO Valley-Wide Health Systems, Inc. 7195895161	Arnoldi, Jania President/CEO Valley-Wide Health Systems 7195871000	3/7/2019 12:44 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	03433561	04280270	2/24/2019 9:33 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1871582536 ( )		2/24/2019 9:33 PM
Details	Last Recertification Date	Update	Recertification	2/22/2018 8:00:34 PM	2/5/2019 7:55:44 PM	2/5/2019 7:55 PM
Details	Last Recertification Date	Update	Recertification	1/27/2017 12:00:00 AM	2/22/2018 8:00:34 PM	2/22/2018 8:00 PM
Contacts	Authorizing Official	Update		DARRICADES, JEANNE PRESIDENT/CEO 7195895161	DARRICADES, JEANNE PRESIDENT/CEO Valley-Wide Health Systems, Inc. 7195895161	10/18/2017 5:06 PM
Contacts	Primary Contact	Update		Hanel, Justin Pharmacist 7195893633	Hanel, Justin Pharmacist Valley-Wide Health Systems, Inc. 7195893633	9/26/2017 10:45 AM
Contacts	Primary Contact	Insert			Hanel, Justin Pharmacist 7195893633	3/11/2017 9:47 PM
Contacts	Authorizing Official	Update		VELASQUEZ, RICARDO INTERIM CEO/PRESIDENT 7195895161	DARRICADES, JEANNE PRESIDENT/CEO 7195895161	3/11/2017 9:47 PM
Addresses	Main Address	Insert			903 S 12th St Rocky Ford, CO 81067-2127	1/27/2017 5:11 PM
Details	Last Recertification Date	Update		2/23/2016 12:00:00 AM	1/27/2017 12:00:00 AM	1/27/2017 5:11 PM
Details	Last Recertification Date	Update		2/11/2015 12:00:00 AM	2/23/2016 12:00:00 AM	2/23/2016 11:02 AM
Details	Last Recertification Date	Update		2/11/2014 12:00:00 AM	2/11/2015 12:00:00 AM	2/11/2015 10:44 AM
Medicaid Billing	Medicaid: Number	Update		05638200	03433561	6/20/2014 10:20 AM
Medicaid Billing	NPI: Number	Insert			1871582536	6/20/2014 10:20 AM
Medicaid Billing	NPI: Number	Insert			1104813682	6/20/2014 10:20 AM
Details	Entity Name	Update		VALLEY WIDE HEALTH SYSTEMS, INC	VALLEY WIDE HEALTH SYSTEMS, INC.	3/31/2014 4:25 PM
Details	Entity Subname	Update		ROCKY FORD CLINIC or ROCKY FORD DENTAL CLINIC	Rocky Ford Clinic or Rocky Ford Dental Clinic	3/31/2014 4:25 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/11/2014 12:00:00 AM	2/11/2014 3:53 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/13/2013 2:23 PM
Details	Entity Subname	Update		ROCKY FORD CLINIC	ROCKY FORD CLINIC or ROCKY FORD DENTAL CLINIC	11/23/2011 11:25 AM
Details	Comments Public	Insert			11/23/11 - Modified sub division name to include dental clinic. 3/16/09 ADDR CHANGE (WAS 405 N. 12TH STREET)2/26/07 - UPDATED ENTITY NAME (WAS VALLEY WIDE HEALTH SERVICES)	11/23/2011 11:25 AM
Contacts	Authorizing Official	Insert			VELASQUEZ, RICARDO INTERIM CEO/PRESIDENT 7195895161	5/19/2011 10:53 AM
Details	Last Recertification Date	Insert				3/16/2009 9:48 AM
Details	Grant Number	Insert			H80CS00134	3/16/2009 9:48 AM
Details	340B ID	Insert			CH08003N	3/16/2009 9:48 AM
Details	Is Authorizing Official EHB Data	Insert				3/16/2009 9:48 AM
Dates	Last Date That 340B Drugs Purchased	Insert				3/16/2009 9:48 AM
Details	Medicare Provider Number	Insert				3/16/2009 9:48 AM
Details	Entity Name	Insert			VALLEY WIDE HEALTH SYSTEMS, INC	3/16/2009 9:48 AM
Details	Program Code	Insert			CH	3/16/2009 9:48 AM
Details	Entity Subname	Insert			ROCKY FORD CLINIC	3/16/2009 9:48 AM
Dates	Participating Approval Date	Insert			5/13/2005 12:00:00 AM	3/16/2009 9:48 AM
Details	State	Insert			Active	3/16/2009 9:48 AM
Dates	Registration Date	Insert			7/1/2001 12:00:00 AM	3/16/2009 9:48 AM
Dates	Signed By Date	Insert				3/16/2009 9:48 AM
Dates	Start Date	Insert			7/1/2001 12:00:00 AM	3/16/2009 9:48 AM
Terminations	Termination Comments	Insert				3/16/2009 9:48 AM
Terminations	Termination Date	Insert				3/16/2009 9:48 AM
Terminations	Termination Effective Date	Insert				3/16/2009 9:48 AM
Terminations	Termination Reason	Insert				3/16/2009 9:48 AM
Details	Comments Public	Insert			3/16/09 ADDR CHANGE (WAS 405 N. 12TH STREET)2/26/07 - UPDATED ENTITY NAME (WAS VALLEY WIDE HEALTH SERVICES)	3/16/2009 9:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/1/2001 12:00 AM
Medicaid Billing	Medicaid: Number	Insert			05638200	7/1/2001 12:00 AM
Medicaid Billing	Medicaid: State	Insert			CO	7/1/2001 12:00 AM

340B Drug Pricing Program Database