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CH081460 PEAK VISTA COMMUNITY HEALTH CENTERS (Active)
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Main Details
Name
PEAK VISTA COMMUNITY HEALTH CENTERS
Subdivision Name
Peak Vista Administrative Services Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-014303
340B ID
CH081460
Grant Number
H80CS00212
Additional Details
Current Program Status
Active
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
3/30/2005
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
PVCHC
Joel Tanaka, Chief Medical Officer
(719) 344-6530
Primary Contact
Peak Vista Community Health Centers
Katie Boudreaux, Vice President of Pharmacy Services
(719) 344-6269
Addresses
Street Address
3205 N Academy Blvd Ste 130
Colorado Springs, CO 80917
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History
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11/28/14 rejected change because EHB's site file still shows the organization's address as 340 Printers Pkwy; 5/2/12 - Removed sub name which was listed as Family Health Center at Myron Stratton. 5/1/12 - Changed main address and billing back to 410 Gold Pass Heights. 4/9/12 - Added sub division name and changed addresses from 340 PRINTERS PARKWAY and added NPI and Medicaid #'s. NEW ENTITY NAME, CONTACT, ADDRESS (FORMERLY 2828 INTERNATIONAL CIRCLE) 7/13/11 - CHANGED AO FROM BJ SCOTT AND CONTACT FROM PAMELA J. MCMANUS.
11/28/2014
5/2/12 - Removed sub name which was listed as Family Health Center at Myron Stratton. 5/1/12 - Changed main address and billing back to 410 Gold Pass Heights. 4/9/12 - Added sub division name and changed addresses from 340 PRINTERS PARKWAY and added NPI and Medicaid #'s. NEW ENTITY NAME, CONTACT, ADDRESS (FORMERLY 2828 INTERNATIONAL CIRCLE) 7/13/11 - CHANGED AO FROM BJ SCOTT AND CONTACT FROM PAMELA J. MCMANUS.
05/02/2012
5/1/12 - Changed main address and billing back to 410 Gold Pass Heights. 4/9/12 - Added sub division name and changed addresses from 340 PRINTERS PARKWAY and added NPI and Medicaid #'s. NEW ENTITY NAME, CONTACT, ADDRESS (FORMERLY 2828 INTERNATIONAL CIRCLE) 7/13/11 - CHANGED AO FROM BJ SCOTT AND CONTACT FROM PAMELA J. MCMANUS.
05/01/2012
4/9/12 - Added sub division name and changed addresses from 340 PRINTERS PARKWAY and added NPI and Medicaid #'s. NEW ENTITY NAME, CONTACT, ADDRESS (FORMERLY 2828 INTERNATIONAL CIRCLE) 7/13/11 - CHANGED AO FROM BJ SCOTT AND CONTACT FROM PAMELA J. MCMANUS.
04/09/2012
NEW ENTITY NAME, CONTACT, ADDRESS (FORMERLY 2828 INTERNATIONAL CIRCLE) 7/13/11 - CHANGED AO FROM BJ SCOTT AND CONTACT FROM PAMELA J. MCMANUS.
07/14/2011
NEW ENTITY NAME, CONTACT, ADDRESS (FORMERLY 2828 INTERNATIONAL CIRCLE) 7/13/11 - CHANGED AO FROM BJ SCOTT AND CONTACT FROM PAMELA J. MCMANUS.
07/14/2011
May 2025
May 2025
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