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CH081460Y PEAK VISTA COMMUNITY HEALTH CENTERS (Active)
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Main Details
Name
PEAK VISTA COMMUNITY HEALTH CENTERS
Subdivision Name
Pediatric Health Center at International Circle
Type
HRSA-Funded Health Center
Site ID
BPS-H80-010559
340B ID
CH081460Y
Grant Number
H80CS00212
Additional Details
Current Program Status
Active
Registration Date
8/11/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/2/2011
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
2828 International Circle STE 140
Colorado Springs, CO 80910
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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NEW ENTITY NAME, CONTACT, ADDRESS (FORMERLY 2828 INTERNATIONAL CIRCLE) 7/13/11 - CHANGED AO FROM BJ SCOTT AND CONTACT FROM PAMELA J. MCMANUS.
08/11/2011
April 2025
April 2025
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