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CH08146S PEAK VISTA COMMUNITY HEALTH CENTERS (Active)
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Main Details
Name
PEAK VISTA COMMUNITY HEALTH CENTERS
Subdivision Name
Health Center at Divide
Type
HRSA-Funded Health Center
Site ID
BPS-H80-005204
340B ID
CH08146S
Grant Number
H80CS00212
Additional Details
Current Program Status
Active
Registration Date
9/2/2005
Participating Start Date
9/9/2005
Participating Approval Date
9/9/2005
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
34 Hybrook Rd S
Divide, CO 80814
Billing Address
PEAK VISTA COMMUNITY HEALTH CENTERS
3205 N. Academy Blvd, Suite 130
COLORADO SPRINGS, CO 80917
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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4/16/2008-UPDATED SHIPPING ADD. (2828 INTERNATIONAL CIRCLE)
04/16/2008
April 2025
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