340B Drug Pricing Program Database
WALGREEN CO.
CH08165S Clinica Campesina Family Health Services - information as of 4/29/2025 1:04:13 AM
Covered Entity Details
Entity Name
Clinica Campesina Family Health Services
Subdivision Name
Clinica Family Health - Lafayette
Type
HRSA-Funded Health Center
340B ID
CH08165S
Entity Address
1735 S Public Rd
Lafayette, CO 80026
Grant Number
H80CS00690
Participating Start Date
7/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 04667
1601 W. 84TH AVE.
FEDERAL HEIGHTS, CO 80260-5001
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/6/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Simon Smith, CEO
(303) 665-3036 Ext: 1003
Contract Pharmacy Representative
Walgreens
Tony Joe Chriscoe, 340 Client Relations Analyst
(847) 315-5806
Signed By Date
10/8/2018
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