The Coast-to-Coast Consortium (C2C) proposes Strong UBR Recruitment, Retention, and Facilitation through innovation (SURRF). C2C combines experienced and new sites to provide innovative and committed support to NIH goals for (1) strong underrepresented in biomedical research (UBR) enrollment, retention, and engagement; (2) use of implementation science best practices; and (3) increase return of value to participants. Our use of implementation science will improve data-driven decision making, and establish the right balance between costs per participant and successful recruitment and retention of UBR participants. Our institutions (Table 2.1) will recruit a total of 68,222, with 80% UBR (Table 2.2). This will be accomplished through new outreach and partnerships that take advantage of our extensive catchment areas. Within >80% overall UBR representation, we expect >50% based on race/ethnicity, and >20% on low-income. We will increase UBR community-based partnerships by at least 20%, and we will have >60% retention by Year 5. Five of our institutions are founding members of the All of Us Research Program (AoU) California Precision Medicine Consortium (CAPMC), which has met or exceeded its milestones for recruitment, retention, including UBRs, for the past six years. The new sites were chosen because they complement existing sites not only with highly diverse populations, but also diversification in institution types and locations: RIQI, a Health Information Exchange (HIE) covering the whole state of Rhode Island; PRCCI, a research institute with sites all over Puerto Rico; and Yale, a research university in the state of Connecticut. An HIE will allow us to understand the efficacy of shifting the existing model of having healthcare provider organizations (HPOs) recruit from their sites, to having the hub of a network of organizations select among any of its contributing sites, allowing to focus on sites enriched for UBRs. PRCCI is a consortium of clinical research sites in Puerto Rico, where 74% of the population is UBR. The population covered by Yale New Haven Health reflects the contrasts of Connecticut, which has the highest per capita income in the country, but where 25% of the population lives in poverty. Of the four new institutions, three have begun already started recruiting via supplements to CAPMC (Yale and PRCCI) or via the AoU Nutrition for Precision Health study (UCLA). Our multidisciplinary team has a strong track record of collaborative research, which facilitates working together successfully. Contact PI Lucila Ohno-Machado has been the contact PI for CAPMC, and she has more than 25 years of experience serving as PI/program director (PI/PD) for NIH research/training grants and service contracts. Dr. Ohno-Machado has deep working relationships with each PI and provides an inclusive, collaborative environment. Our multi-PI team has a combination of leaders in their fields and emerging leaders, and itself represents the diversity we strive to recruit and retain. Of 11 MPIs, only four are male; various racial and ethnic groups are represented; there are MDs, MD/PhDs, and PhDs in various areas. Our staff are equally diverse and reflect the communities we serve. We have established partnerships and will continue to collaborate with the San Diego Blood Bank (also in the AoU Direct Volunteer Program), various Federally Qualified Healthcare Centers (FQHC), as well as multiple community partners. We share lessons learned and value the privilege of being part of AoU. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction.