Covered Entity Details

CH05218K RURAL HEALTH INC (Terminated) - information as of 6/12/2025 5:20:17 AM

Main Details

Name

RURAL HEALTH INC

Subdivision Name

AJ SCHOOL HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-005135

340B ID

CH05218K

Grant Number

H80CS00711

Additional Details

Current Program Status

Terminated

Registration Date

4/15/2013

Participating Start Date

7/1/2013

Participating Approval Date

6/17/2013

Last Recertification Date

3/3/2016

Termination Date
Termination Reason

4/1/2017
Site closure

Contacts

Authorizing Official

Rural Health, Inc.
Cindy Flamm, CEO
(618) 833-4471 Ext: 1015

Primary Contact

Kurt Petrich, Director of Clinical Operations
(618) 833-4471 Ext: 1030

Addresses

Street Address

608 S. MAIN ST
ANNA, IL 62906-1247

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH052180	Active	BPS-H80-004503	RURAL HEALTH, INC.	ANNA MEDICAL CLINIC	513 NORTH MAIN STREET	ANNA	IL
CH05218C	Active	BPS-H80-004500	RURAL HEALTH, INC.	DONGOLA MEDICAL CLINIC	318 NORTH HIGHWAY 51	DONGOLA	IL
CH05218D	Active	BPS-H80-001855	RURAL HEALTH, INC.	VIENNA MEDICAL CENTER	803 NORTH 1ST STREET	VIENNA	IL
CH05218J	Active	BPS-H80-035171	RURAL HEALTH, INC.	Goreville Clinic	211 N Broadway	Goreville	IL
CH05218K	Terminated	BPS-H80-005135	RURAL HEALTH INC	AJ SCHOOL HEALTH CENTER	608 S. MAIN ST	ANNA	IL
CH05218M	Active	BPS-H80-018475	RURAL HEALTH, INC.	Metropolis Medical Clinic	1003 E. 5th	Metropolis	IL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH052180	BODE DRUG	211 MAIN ST	P.O. BOX 110	MOUND CITY	IL	62963-0110	01/01/2023
CH052180	BODE DRUG INC	803 1/2 N 1ST ST		VIENNA	IL	62995-1544	10/01/2016
CH052180	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04219	206 S. WALL ST.	CARBONDALE	IL	62901	01/01/2016
CH052180	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2021
CH052180	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2021
CH052180	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2021
CH052180	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2021
CH052180	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2021
CH052180	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2021
CH052180	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2021
CH052180	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2021
CH052180	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2021
CH052180	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2021
CH052180	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2021
CH052180	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2021
CH052180	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2021
CH05218D	DAHNCKE PHARMACY		803 1/2 NORTH FIRST STREET PO BOX 1266	VIENNA	IL	62995	07/28/2006	02/28/2016
CH052180	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06388	801 W. MAIN ST.	MARION	IL	62959	01/01/2020
CH052180	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06390	2431 W. MAIN ST.	CARBONDALE	IL	62901	01/01/2020
CH052180	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06372	705 WEST MAINST.	BENTON	IL	62812	07/01/2020
CH052180	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 03188	ONE SOUTH COMMERCIAL STREET	HARRISBURG	IL	62946	01/01/2021
CH052180	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06373	304 W. MAIN ST.	WEST FRANKFORT	IL	62896	01/01/2021
CH052180	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02713	753 W HWY 50	O'FALLON	IL	62269	07/01/2021
CH052180	HIGHLAND PARK CVS, L.L.C.	CVS/PHARMACY #18085	915 W MAIN ST	CARBONDALE	IL	62901	10/01/2024
CH052180	KENTUCKY CENTRAL FILL FACILITY, L-010	5594 SHEPHERDSVILLE ROAD		LOUISVILLE	KY	40228-1012	04/01/2016
CH052180	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02586	3001 LONE OAK ROAD	PADUCAH	KY	42003	01/01/2020
CH052180	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06379	3275 IRVIN COBB DR.	PADUCAH	KY	42003	01/01/2020
CH052180	KENTUCKY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06376	538 LONE OAK RD.	PADUCAH	KY	42003	01/01/2020
CH052180	KROGER PHARMACY L-714	501 NORTH GIANT CITY ROAD		CARBONDALE	IL	62902	04/01/2016
CH052180	KROGER PHARMACY L672	45 PLAZA DR		ANNA	IL	62906-2034	04/01/2016
CH052180	MEDICAP PHARMACY	1785 E. VIENNA ST.	P O BOX 683	ANNA	IL	62906	04/01/2021	04/15/2024
CH052180	METROPOLIS DRUGS I	1001 E 5TH ST		METROPOLIS	IL	62960-2311	01/01/2022
CH052180	METROPOLIS DRUGS II	LAWSON, LESLIE JO	1201 W 10TH ST	METROPOLIS	IL	62960-2433	04/01/2022	04/15/2024
CH052180	MISSOURI CVS PHARMACY, L.L.C.	CVS PHARMACY # 16385	202 SIEMERS DR	CAPE GIRARDEAU	MO	63701	07/01/2020
CH052180	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10256	2161 WILLIAM ST.	CAPE GIRARDEAU	MO	63703	07/01/2020
CH052180	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #18074	19 S KINGSHIGHWAY	CAPE GIRARDEAU	MO	63703-5742	07/01/2021
CH052180	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2021
CH052180	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2021
CH052180	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2021
CH052180	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2021
CH052180	ROGAN'S COUNTRY PHARMACY	ROGAN, DEAN L SR	201 E COMMERCIAL AVE P.O. BOX 241	PULASKI	IL	62976-2534	01/01/2022
CH052180	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2020
CH052180	WAL-MART PHARMACY 10-0233	300 LEIGH AVENUE		ANNA	IL	62906	01/01/2016
CH052180	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2020
CH052180	WALGREEN CO	DBA: WALGREENS #12890	503 WALNUT STREET	MURPHYSBORO	IL	62966	04/01/2018
CH052180	WALGREEN CO.	DBA: WALGREENS # 07578	1710 W DEYOUNG STREET	MARION	IL	62959-1054	04/01/2015
CH052180	WALGREEN CO.	DBA: WALGREENS #12504	110 W 10TH ST	METROPOLIS	IL	62960	04/01/2015
CH052180	WALGREEN CO.	DBA: WALGREENS #12581	745 E VIENNA ST	ANNA	IL	62906	04/01/2015
CH052180	WALGREEN CO.	DBA: WALGREENS #13004	1600 W. MAIN ST	CARBONDALE	IL	62901	01/01/2018
CH052180	WALGREEN CO.	DBA: WALGREENS #12089	1606 S. PARK AVE.	HERRIN	IL	62948	01/01/2019
CH052180	WALGREEN CO.	DBA: WALGREENS # 03338	1 S KINGSHIGHWAY	CAPE GIRARDEAU	MO	63703	04/01/2019
CH052180	WALGREEN CO.	DBA: WALGREENS # 09253	3360 IRVING COBB DR	PADUCAH	KY	42003	01/01/2022
CH052180	WALGREEN CO.	DBA: WALGREENS # 06429	521 LONE OAK ROAD	PADUCAH	KY	42003	04/01/2022
CH052180	WALGREEN CO.	DBA: WALGREENS # 10844	3132 OLD JACKSONVILLE RD SUITE 100	SPRINGFIELD	IL	62704-7400	07/01/2022	07/11/2022
CH052180	Walgreens #21389	Walgreens Central Fill #21389	3299 Tchulatech Dr Suite 101	Memphis	TN	38118	07/01/2022
CH052180	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/01/2015	06/17/2015
CH052180	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2015	06/17/2015
CH052180	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH052180	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update		Flamm, Cindy CEO 6188334471-1015	Flamm, Cindy CEO Rural Health, Inc. 6188334471-1015	10/3/2017 11:07 AM
Contacts	Signed By	Update	Profile Change Request	Stewart, Jodie Director of Nursing Rural Health, Inc. 6188334471-142	Stewart, Jodie Director of Quality Management Rural Health, Inc. 6188334471-1034	10/3/2017 10:52 AM
Contacts	Signed By	Update		Stewart, Jodie Director of Nursing 6188334471-142	Stewart, Jodie Director of Nursing Rural Health, Inc. 6188334471-142	10/3/2017 10:39 AM
Contacts	Primary Contact	Update		Miller, Brooke PA-C, MPAS 6188333233	Petrich, Kurt Director of Clinical Operations 6188334471-1030	3/16/2017 10:47 AM
Contacts	Authorizing Official	Insert			Flamm, Cindy CEO 6188334471-1015	3/16/2017 10:47 AM
Contacts	Signed By	Insert			Stewart, Jodie Director of Nursing 6188334471-142	2/6/2017 3:41 PM
Addresses	Main Address	Insert			608 S. MAIN ST ANNA, IL 62906-1247	1/22/2017 3:29 PM
Dates	Last Date That 340B Drugs Purchased	Update			5/27/2016 12:00:00 AM	1/22/2017 3:29 PM
Details	State	Update		Active	Terminated	1/22/2017 3:29 PM
Terminations	Termination Date	Update			4/1/2017 12:00:00 AM	1/22/2017 3:29 PM
Terminations	Termination Effective Date	Update			6/1/2016 12:00:00 AM	1/22/2017 3:29 PM
Terminations	Termination Reason	Update			Site closure	1/22/2017 3:29 PM
Details	Last Recertification Date	Update		3/5/2015 12:00:00 AM	3/3/2016 12:00:00 AM	3/3/2016 10:53 PM
Contacts	Primary Contact	Insert			Miller, Brooke PA-C, MPAS 6188333233	3/5/2015 11:46 AM
Details	Last Recertification Date	Update		3/14/2014 12:00:00 AM	3/5/2015 12:00:00 AM	3/5/2015 11:46 AM
Details	Is Authorizing Official EHB Data	Update			False	3/5/2015 11:46 AM
Details	Last Recertification Date	Update			3/14/2014 12:00:00 AM	3/14/2014 12:14 PM
Details	340B ID	Update		IS-FN-CH05218K	CH05218K	6/17/2013 5:09 PM
Dates	Participating Approval Date	Update			6/17/2013 12:00:00 AM	6/17/2013 5:09 PM
Details	State	Update		Pending	Active	6/17/2013 5:09 PM
Dates	Start Date	Update			7/1/2013 12:00:00 AM	6/17/2013 5:09 PM
Details	340B ID	Update		FN?-CH05218K	IS-FN-CH05218K	6/17/2013 2:07 PM
Details	340B ID	Update		IS-FN-CH05218K	FN?-CH05218K	6/17/2013 1:20 PM
Details	340B ID	Update		FN?-CH05218K	IS-FN-CH05218K	6/12/2013 5:05 PM
Details	340B ID	Update		IS-FN-CH05218K	FN?-CH05218K	6/11/2013 5:10 PM
Details	340B ID	Update		ONLINE_REG	IS-FN-CH05218K	4/28/2013 8:09 PM
Details	Last Recertification Date	Insert				4/15/2013 3:35 PM
Details	Grant Number	Insert			H80CS00711	4/15/2013 3:35 PM
Details	340B ID	Insert			ONLINE_REG	4/15/2013 3:35 PM
Details	Is Authorizing Official EHB Data	Insert				4/15/2013 3:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/15/2013 3:35 PM
Details	Medicare Provider Number	Insert				4/15/2013 3:35 PM
Details	Entity Name	Insert			RURAL HEALTH INC	4/15/2013 3:35 PM
Details	Program Code	Insert			CH	4/15/2013 3:35 PM
Details	Entity Subname	Insert			AJ SCHOOL HEALTH CENTER	4/15/2013 3:35 PM
Dates	Participating Approval Date	Insert				4/15/2013 3:35 PM
Details	State	Insert			Pending	4/15/2013 3:35 PM
Dates	Registration Date	Insert			4/15/2013 12:00:00 AM	4/15/2013 3:35 PM
Dates	Signed By Date	Insert			4/15/2013 12:00:00 AM	4/15/2013 3:35 PM
Dates	Start Date	Insert				4/15/2013 3:35 PM
Terminations	Termination Comments	Insert				4/15/2013 3:35 PM
Terminations	Termination Date	Insert				4/15/2013 3:35 PM
Terminations	Termination Effective Date	Insert				4/15/2013 3:35 PM
Terminations	Termination Reason	Insert				4/15/2013 3:35 PM

340B Drug Pricing Program Database