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CH08017C PUEBLO COMMUNITY HEALTH CENTER (Active)
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Main Details
Name
PUEBLO COMMUNITY HEALTH CENTER
Subdivision Name
O'ROURKE DENTAL CLINIC
Type
HRSA-Funded Health Center
Site ID
BPS-H80-005563
340B ID
CH08017C
Grant Number
H80CS00692
Additional Details
Current Program Status
Active
Registration Date
10/1/2003
Participating Start Date
10/1/2003
Participating Approval Date
5/11/2005
Last Recertification Date
3/2/2025
Contacts
Authorizing Official
Pueblo Community Health Center, Inc.
Donald Moore, CEO
(719) 543-8718 Ext: 139
Primary Contact
Pueblo Community Health Center
Phillip L Davis, CFO
(719) 543-8718 Ext: 295
Addresses
Street Address
2030 Lake Ave
Pueblo, CO 81004-3536
Billing Address
Pueblo Community Health Center
110 E Routt Avenue
Pueblo, CO 81004
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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ADD 10/1/03 5/11/05 ADD MED# CHANGE CONTACT NAME, PHONES
05/26/2011
ADD 10/1/03 5/11/05 ADD MED# CHANGE CONTACT NAME, PHONES
05/26/2011
April 2025
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