| Contacts | Primary Contact | Update | Recertification | Hemerka, Sharon
340B Drug Program Coordinator
Yavapai, County of
9285831000 | Schmidt, Cody
Pharmacy and 340b Section Manager
Yavapai County Community Health Services
9285831038 | 5/6/2025 6:11 AM |
| Details | Last Recertification Date | Update | Recertification | | 5/6/2025 6:11:58 AM | 5/6/2025 6:11 AM |
| Details | State | Update | | Approved | Active | 7/1/2024 12:01 AM |
| Addresses | Main Address | Insert | Reinstatement | |
3212 N WINDSONG DRIVE
PRESCOTT VALLEY, AZ 86314 | 4/23/2024 8:37 AM |
| Addresses | Billing Address | Insert | Reinstatement | | COMMUNITY HEALTH CENTER OF YAVAPAI - PRESCOTT CLINIC
1090 COMMERCE DRIVE
PRESCOTT, AZ 86305 | 4/23/2024 8:37 AM |
| Medicaid Billing | Medicaid: Number | Delete | Reinstatement | 906271 (AZ) | | 4/23/2024 8:37 AM |
| Medicaid Billing | NPI: Number | Delete | Reinstatement | 1336265982 (AZ) | | 4/23/2024 8:37 AM |
| Contacts | Primary Contact | Update | Reinstatement | Hemerka, Sharon
340B Program Coordinator
Community Health Center of Yavapai
9284425915 | Hemerka, Sharon
340B Drug Program Coordinator
Yavapai, County of
9285831000 | 4/23/2024 8:37 AM |
| Contacts | Authorizing Official | Update | Reinstatement | Rickman, Sharon
Director
Community Health Center of Yavapai
9284425285 | Horton, Leslie
Director, Health Officer
Yavapai, County of
9284425303 | 4/23/2024 8:37 AM |
| Contacts | Signed By | Insert | Reinstatement | | Horton, Leslie
Director, Health Officer
Yavapai, County of
9284425303 | 4/23/2024 8:37 AM |
| Details | Last Recertification Date | Update | Reinstatement | 5/5/2021 1:55:08 PM | | 4/23/2024 8:37 AM |
| Details | Grant Number | Update | Reinstatement | 1 FPHPA006468-01-00 | FPHPA006520 | 4/23/2024 8:37 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 3/31/2022 12:00:00 AM | | 4/23/2024 8:37 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 4/11/2005 12:00:00 AM | 4/23/2024 8:37:24 AM | 4/23/2024 8:37 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 4/23/2024 8:37 AM |
| Dates | Registration Date | Update | Reinstatement | 7/1/2002 12:00:00 AM | 4/2/2024 5:43:52 PM | 4/23/2024 8:37 AM |
| Dates | Signed By Date | Update | Reinstatement | 4/1/2010 12:00:00 AM | 4/4/2024 1:21:13 PM | 4/23/2024 8:37 AM |
| Dates | Start Date | Update | Reinstatement | 7/1/2002 12:00:00 AM | 7/1/2024 12:00:00 AM | 4/23/2024 8:37 AM |
| Terminations | Termination Date | Update | Reinstatement | 7/1/2022 12:00:00 AM | | 4/23/2024 8:37 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 3/31/2022 12:00:00 AM | | 4/23/2024 8:37 AM |
| Terminations | Termination Reason | Update | Reinstatement | Loss of qualifying grant/support | | 4/23/2024 8:37 AM |
| Details | Comments Public | Insert | Reinstatement | | Participating from effective date: (07/1/2002) until terminated effective date: (07/1/2022); reinstatement effective date: (07/1/2024) | 4/17/2024 7:21 AM |
| Details | State | Update | | To Be Terminated | Terminated | 7/1/2022 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 3/31/2022 12:00:00 AM | 5/3/2022 7:00 AM |
| Details | State | Update | Termination Request | Active | To Be Terminated | 5/3/2022 7:00 AM |
| Terminations | Termination Date | Update | Termination Request | | 7/1/2022 12:00:00 AM | 5/3/2022 7:00 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 3/31/2022 12:00:00 AM | 5/3/2022 7:00 AM |
| Terminations | Termination Reason | Update | Termination Request | | Loss of qualifying grant/support | 5/3/2022 7:00 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | AZ | 5/5/2021 1:55 PM |
| Details | Last Recertification Date | Update | Recertification | 5/4/2020 5:57:52 PM | 5/5/2021 1:55:08 PM | 5/5/2021 1:55 PM |
| Addresses | Main Address | Update | Change Request |
3212 N WINDSONG DRIVE
SECOND FLOOR
PRESCOTT VALLEY, AZ 86314 |
3212 N WINDSONG DRIVE
PRESCOTT VALLEY, AZ 86314 | 3/29/2021 8:40 AM |
| Details | Last Recertification Date | Update | Recertification | 5/20/2019 8:22:49 AM | 5/4/2020 5:57:52 PM | 5/4/2020 5:57 PM |
| Contacts | Primary Contact | Update | Change Request | Lowman, Kathy
Program Coordinator
Community Health Center of Yavapai
9284425286 | Hemerka, Sharon
340B Program Coordinator
Community Health Center of Yavapai
9284425915 | 1/23/2020 1:09 PM |
| Details | Last Recertification Date | Update | Recertification | 4/25/2018 6:59:08 PM | 5/20/2019 8:22:49 AM | 5/20/2019 8:22 AM |
| Details | Grant Number | Update | Recertification | FPHPA096240 | 1 FPHPA006468-01-00 | 5/20/2019 8:22 AM |
| Details | Last Recertification Date | Update | Recertification | 4/28/2017 12:00:00 AM | 4/25/2018 6:59:08 PM | 4/25/2018 6:59 PM |
| Contacts | Authorizing Official | Update | | Rickman, Sharon
Director
9284425285 | Rickman, Sharon
Director
Community Health Center of Yavapai
9284425285 | 10/3/2017 1:06 PM |
| Contacts | Primary Contact | Update | | Lowman, Kathy
Program Coordinator
9284425286 | Lowman, Kathy
Program Coordinator
Community Health Center of Yavapai
9284425286 | 9/29/2017 11:10 AM |
| Contacts | Primary Contact | Insert | | | Lowman, Kathy
Program Coordinator
9284425286 | 7/31/2017 2:07 PM |
| Contacts | Authorizing Official | Update | | Olson, Annette
Clinic Director
9284425285 | Rickman, Sharon
Director
9284425285 | 7/31/2017 2:07 PM |
| Addresses | Main Address | Insert | | |
3212 N WINDSONG DRIVE
SECOND FLOOR
PRESCOTT VALLEY, AZ 86314 | 4/28/2017 6:16 PM |
| Details | Last Recertification Date | Update | | 6/1/2016 12:00:00 AM | 4/28/2017 12:00:00 AM | 4/28/2017 6:16 PM |
| Addresses | Billing Address | Insert | | | COMMUNITY HEALTH CENTER OF YAVAPAI - PRESCOTT CLINIC
1090 COMMERCE DRIVE
PRESCOTT, AZ 86305 | 1/31/2017 7:56 AM |
| Details | Entity Subname | Update | | YAVAPAI COUNTY COMMUNITY HEALTH SERVICES - PRESCOTT VALLEY CLINIC | COMMUNITY HEALTH CENTER OF YAVAPAI- PRESCOTT VALLEY CLINIC | 1/31/2017 7:56 AM |
| Contacts | Authorizing Official | Update | | Nies, Peggy
Clinic Director
9284425285 | Olson, Annette
Clinic Director
9284425285 | 6/1/2016 11:25 AM |
| Details | Last Recertification Date | Update | | 5/20/2015 12:00:00 AM | 6/1/2016 12:00:00 AM | 6/1/2016 11:20 AM |
| Details | Grant Number | Update | | FPHPA096062 | FPHPA096240 | 5/16/2016 7:35 AM |
| Medicaid Billing | Medicaid: Number | Update | | 188591 | 906271 | 5/20/2015 1:09 PM |
| Medicaid Billing | NPI: Number | Update | | 1659317022 | 1336265982 | 5/20/2015 1:09 PM |
| Contacts | Authorizing Official | Insert | | | Nies, Peggy
Clinic Director
9284425285 | 5/20/2015 1:09 PM |
| Details | Last Recertification Date | Update | | 4/25/2014 12:00:00 AM | 5/20/2015 12:00:00 AM | 5/20/2015 1:09 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 9/12/2014 6:45 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 188591 | 9/12/2014 6:45 AM |
| Medicaid Billing | Medicaid: State | Insert | | | AZ | 9/12/2014 6:45 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1659317022 | 9/12/2014 6:45 AM |
| Details | Last Recertification Date | Update | | 7/1/2013 12:00:00 AM | 4/25/2014 12:00:00 AM | 4/25/2014 8:23 AM |
| Details | Grant Number | Update | | FPHPA6062A | FPHPA096062 | 4/3/2014 12:46 PM |
| Details | Grant Number | Update | | FPHPA091701 | FPHPA6062A | 10/30/2013 10:05 AM |
| Details | Last Recertification Date | Update | | 4/1/2012 12:00:00 AM | 7/1/2013 12:00:00 AM | 5/15/2013 9:23 AM |
| Details | Last Recertification Date | Update | | 4/1/2010 12:00:00 AM | 4/1/2012 12:00:00 AM | 3/26/2012 9:39 PM |
| Details | Entity Name | Update | | ARIZONA FAMILY PLANNING COUNCIL | ARIZONA FAMILY HEALTH PARTNERSHIP | 3/26/2012 9:39 PM |
| Details | Entity Subname | Update | | YAVAPAI COUNTY HEALTH DEPARTMENT - PRESCOTT VALLEY CLINIC | YAVAPAI COUNTY COMMUNITY HEALTH SERVICES - PRESCOTT VALLEY CLINIC | 3/26/2012 9:39 PM |
| Details | Last Recertification Date | Insert | | | 4/1/2010 12:00:00 AM | 2/18/2010 8:06 AM |
| Details | Grant Number | Insert | | | FPHPA091701 | 2/18/2010 8:06 AM |
| Details | 340B ID | Insert | | | FP86314 | 2/18/2010 8:06 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 2/18/2010 8:06 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 2/18/2010 8:06 AM |
| Details | Medicare Provider Number | Insert | | | | 2/18/2010 8:06 AM |
| Details | Entity Name | Insert | | | ARIZONA FAMILY PLANNING COUNCIL | 2/18/2010 8:06 AM |
| Details | Program Code | Insert | | | FP | 2/18/2010 8:06 AM |
| Details | Entity Subname | Insert | | | YAVAPAI COUNTY HEALTH DEPARTMENT - PRESCOTT VALLEY CLINIC | 2/18/2010 8:06 AM |
| Dates | Participating Approval Date | Insert | | | 4/11/2005 12:00:00 AM | 2/18/2010 8:06 AM |
| Details | State | Insert | | | Active | 2/18/2010 8:06 AM |
| Dates | Registration Date | Insert | | | 7/1/2002 12:00:00 AM | 2/18/2010 8:06 AM |
| Dates | Signed By Date | Insert | | | 4/1/2010 12:00:00 AM | 2/18/2010 8:06 AM |
| Dates | Start Date | Insert | | | 7/1/2002 12:00:00 AM | 2/18/2010 8:06 AM |
| Terminations | Termination Comments | Insert | | | | 2/18/2010 8:06 AM |
| Terminations | Termination Date | Insert | | | | 2/18/2010 8:06 AM |
| Terminations | Termination Effective Date | Insert | | | | 2/18/2010 8:06 AM |
| Terminations | Termination Reason | Insert | | | | 2/18/2010 8:06 AM |