Covered Entity Details

CH07055AG PRIMARY HEALTH CARE INC (Terminated) - information as of 4/25/2025 10:07:21 PM

Main Details

Name

PRIMARY HEALTH CARE INC

Subdivision Name

Primary Health Care, Inc. - Homeless Advocacy Program

Type

HRSA-Funded Health Center

Site ID

BPS-H80-018643

340B ID

CH07055AG

Grant Number

H80CS00715

Additional Details

Current Program Status

Terminated

Registration Date

10/7/2016

Participating Start Date

1/1/2017

Participating Approval Date

10/24/2016

Last Recertification Date

2/8/2021

Termination Date
Termination Reason

4/1/2022
Other

Contacts

Authorizing Official

Primary Health Care
Kelly Huntsman, CEO
(515) 248-1441

Primary Contact

Primary Health Care
Heidi Price-Eastman, Pharmacy Director
(515) 248-1558

Addresses

Street Address

1200 University Ave.
110A
Des Moines, IA 50314-2343

Billing Address

Primary Health Care, Inc.
1200 University Ave
200
Des Moines, IA 50314

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

Shipping Address 1

Primary Health Care Pharmacy
1200 University Ave
105
Des Moines, IA 50314

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
CH07055A	Active	BPS-H80-002479	Primary Health Care, Inc.	Primary Health Care - Bery Engebretsen Clinic	2353 SE 14th St	Des Moines	IA
CH07055AA	Terminated	BPS-H80-008661	PRIMARY HEALTH CARE INC	Primary Health Care - Marshalltown Dental Clinic	112 E Linn St	Marshalltown	IA
CH07055AB	Terminated	BPS-H80-012227	PRIMARY HEALTH CARE INC	Primary Health Care at Central Iowa Shelter and Services	1420 Mulberry Street	Des Moines	IA
CH07055AC	Active	BPS-H80-012972	Primary Health Care, Inc.	Primary Health Care at Mercy	250 Laurel St	Des Moines	IA
CH07055AD	Active	BPS-H80-014429	Primary Health Care, Inc	Primary Health Care - Story County	3510 Lincoln Way	Ames	IA
CH07055AE	Terminated	BPS-H80-017170	PRIMARY HEALTH CARE INC	Primary Health Care at Scavo	1800 Grand Ave.	Des Moines	IA
CH07055AF	Terminated	BPS-H80-018641	PRIMARY HEALTH CARE INC	The Project of Primary Health Care	1200 University Ave.	Des Moines	IA
CH07055AG	Terminated	BPS-H80-018643	PRIMARY HEALTH CARE INC	Primary Health Care, Inc. - Homeless Advocacy Program	1200 University Ave.	Des Moines	IA
CH07055AH	Terminated	BPS-H80-018535	PRIMARY HEALTH CARE INC	Primary Health Care, Inc. - Administrative Offices	1200 University Ave.	Des Moines	IA
CH07055AJ	Active	BPS-H80-014471	Primary Health Care, Inc	Primary Health Care - University Dental Clinic	1200 University Ave	Des Moines	IA
CH07055AK	Active	BPS-H80-019316	Primary Health Care Inc	Primary Health Care at Hoover/Meredith	4800 Aurora Ave.	Des Moines	IA
CH07055AL	Active	BPS-H80-030757	Primary Health Care Inc	Primary Health Care - West Side Clinic	7555 Hickman Road	Urbandale	IA
CH07055AM	Active	BPS-H80-019557	Primary Health Care Inc	Primary Health Care - Mobile Unit	1200 University Ave.	Des Moines	IA
CH07055AN	Terminated	BPS-H80-027274	Primary Health Care Inc	Primary Health Care - Marshalltown Specialty Health	704 May St	Marshalltown	IA
CH07055AP	Active	BPS-H80-031241	Primary Health Care, Inc.	Primary Health Care - South Side Clinic	2401 SE 14th St	Des Moines	IA
CH07055AQ	Active	BPS-H80-033504	PRIMARY HEALTH CARE	Primary Health Care at Kurtz Opportunity Center	1000 Porter Ave	Des Moines	IA
CH07055AR	Active	BPS-H80-037370	PRIMARY HEALTH CARE, INC.	Primary Health Care at East High School	815 E 13th St	Des Moines	IA
CH07055C	Active	BPS-H80-034166	Primary Health Care, Inc.	Primary Health Care - Marshalltown Clinic	101 Iowa Ave W STE 102	Marshalltown	IA
CH07055D	Active	BPS-H80-008847	Primary Health Care, Inc.	Primary Health Care - University Clinic	1200 University Ave	Des Moines	IA
CH07055Q	Active	BPS-H80-003563	Primary Health Care, Inc.	Primary Health Care - East Side Clinic	3509 E 29TH ST	Des Moines	IA
CH07055Y	Terminated	BPS-H80-007389	PRIMARY HEALTH CARE INC	Primary Health Care at Youth Emergency Shelter Services	918 SE 11th St	Des Moines	IA
CH07055Z	Terminated	BPS-H80-010961	PRIMARY HEALTH CARE INC	Eyerly Ball Community Mental Health Center	1301 Center St	Des Moines	IA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH07055A	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	01/01/2024
CH07055A	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	01/01/2024
CH07055A	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/17/2024
CH07055A	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/01/2023
CH07055A	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	01/01/2024
CH07055A	ACCREDO HEALTH GROUP, INC.	WHOLESALE DIVISION	1680 CENTURY CENTER PARKWAY, SUITE 8 SUITE 8	MEMPHIS	TN	38134	01/01/2024	04/17/2024
CH07055A	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	01/01/2024
CH07055A	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	01/01/2024
CH07055A	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2023
CH07055A	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2023
CH07055A	HY-VEE	3800 WEST LINCOLN WAY		AMES	IA	50014	07/01/2020
CH07055A	HY-VEE DRUGSTORE #7055	1706 S CENTER STREET		MARSHALLTOWN	IA	50158	01/01/2020	10/15/2020
CH07055A	HY-VEE DRUGSTORE PHARMACY #7031	4100 UNIVERSITY AVENUE		DES MOINES	IA	50311	01/01/2020
CH07055A	HY-VEE FOOD & DRUG #2	HY-VEE FOOD STORES INC	2540 E EUCLID AVENUE	DES MOINES	IA	50317	01/01/2020
CH07055A	HY-VEE PHARMACY	802 SOUTH CENTER ST		MARSHALLTOWN	IA	50158	01/01/2020
CH07055A	HY-VEE PHARMACY	4605 FLEUR DR		DES MOINES	IA	50321	07/01/2020
CH07055A	HY-VEE PHARMACY	640 LINCOLNWAY		AMES	IA	50010	07/01/2020
CH07055A	HY-VEE PHARMACY #6 (1155)	420 COURT AVE.		DES MOINES	IA	50309	01/01/2020
CH07055A	HY-VEE PHARMACY 1895	HY-VEE INC.	7101 UNIVERSITY AVE	WINDSOR HEIGHTS	IA	50324	01/01/2020	10/01/2021
CH07055A	Hy-Vee Pharmacy Fulfillment Center #4016	Hy-Vee Inc	4707 Fleur Dr	Des Moines	IA	50321	01/01/2020
CH07055C	HYVEE PHARMACY	802 SOUTH CENTER STREET		MARSHALLTOWN	IA	50158	04/01/2003	06/24/2015
CH07055A	MEDICAP PHARMACY	GRX HOLDINGS, LLC	2804 BEAVER AVENUE	DES MOINES	IA	50310	10/01/2023
CH07055A	MEDICAP PHARMACY	GRX HOLDINGS, LLC	2527 EASTON BLVD	DES MOINES	IA	50317	10/01/2023
CH07055A	MEDICAP PHARMACY	GRX HOLDINGS LLC	1300 EAST 14TH STREET	DES MOINES	IA	50316	10/01/2023
CH07055A	MEDICAP PHARMACY	GRX HOLDINGS LLC	105 LINCOLN WAY	AMES	IA	50010	10/01/2023
CH07055A	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2020
CH07055A	WAL-MART PHARMACY 10-0581	2802 S. CENTER STREET		MARSHALLTOWN	IA	50158	04/01/2020
CH07055A	WAL-MART PHARMACY 10-0749	3105 GRAND AVENUE		AMES	IA	50010	04/01/2020	10/15/2020
CH07055A	WAL-MART PHARMACY 10-0892	1002 SE NATIONAL DRIVE		ANKENY	IA	50021	04/01/2020	10/15/2020
CH07055A	WAL-MART PHARMACY 10-1389	1515 SE MARSHALL STREET		BOONE	IA	50036	04/01/2020	10/15/2020
CH07055A	WAL-MART PHARMACY 10-1723	5101 SOUTHEAST 14TH STREET		DES MOINES	IA	50320	04/01/2020
CH07055A	WAL-MART PHARMACY 10-1764	1001 73RD ST		WINDSOR HEIGHTS	IA	50324-1311	04/01/2020
CH07055A	WAL-MART PHARMACY 10-2764	3501 8TH STREET SW		ALTOONA	IA	50009	04/01/2020	10/01/2021
CH07055A	WAL-MART PHARMACY 10-3762	6365 STAGECOACH DRIVE		WEST DES MOINES (SW)	IA	50266	04/01/2020	10/15/2020
CH07055A	WAL-MART PHARMACY 10-4256	534 DUFF AVE		AMES	IA	50010	04/01/2020	10/15/2020
CH07055A	WAL-MART PHARMACY 10-5748	2150 E 1ST ST		GRIMES	IA	50111	04/01/2020	10/15/2020
CH07055A	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2020
CH07055A	WALGREEN CO.	DBA: WALGREENS # 00359	2545 E EUCLID AVE	DES MOINES	IA	50317	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 03196	5 E ANSON ST	MARSHALLTOWN	IA	50158	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 03252	606 WALNUT STREET	DES MOINES	IA	50309	04/01/2014	02/29/2024
CH07055A	WALGREEN CO.	DBA: WALGREENS # 04714	4555 FLEUR DRIVE	DES MOINES	IA	50321	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 05362	1330 E. UNIVERSITY	DES MOINES	IA	50316	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 05721	3140 SE 14TH ST	DES MOINES	IA	50320	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 05777	2930 E. UNIVERSITY AVE.	DES MOINES	IA	50317	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 05852	3030 UNIVERSITY AVE	DES MOINES	IA	50311	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 06623	1660 22ND STREET	WEST DES MOINES	IA	50266	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 07452	4415 DOUGLAS AVE	DES MOINES	IA	50310-2717	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 07453	104 E EUCLID AVE	DES MOINES	IA	50313-4507	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 07833	3501 INGERSOLL AVE	DES MOINES	IA	50312-3406	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 07968	6200 SE 14TH STREET	DES MOINES	IA	50320	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 12108	2719 GRAND AVE	AMES	IA	50010	04/01/2014
CH07055A	WALGREEN CO.	DBA: WALGREENS # 06678	1999 GRAND AVE	WEST DES MOINES	IA	50265	01/01/2015
CH07055A	WALGREEN CO.	DBA: WALGREENS # 03773	4600 86TH ST	URBANDALE	IA	50322	04/01/2015
CH07055A	WALGREEN CO.	DBA: WALGREENS # 05060	12753 UNIVERSITY AVE	CLIVE	IA	50325	04/01/2015
CH07055A	WALGREEN CO.	DBA: WALGREENS # 06677	4900 MILLS CIVIC PARKWAY	WEST DES MOINES	IA	50265	04/01/2015
CH07055A	WALGREEN CO.	DBA: WALGREENS # 09791	101 8TH ST SE	ALTOONA	IA	50009-1938	04/01/2015
CH07055A	WALGREEN CO.	DBA: WALGREENS # 07454	901 N ANKENY BLVD	ANKENY	IA	50023-4002	01/01/2019
CH07055A	WALGREEN CO.	DBA: WALGREENS # 07996	2702 SE DELAWARE AVE	ANKENY	IA	50021	01/01/2019
CH07055A	WALGREEN CO.	DBA: WALGREENS # 04973	7000 DOUGLAS AVE	URBANDALE	IA	50322	01/01/2019
CH07055A	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16528	1704 INGERSOLL AVE STE 102	DES MOINES	IA	50309	07/01/2020
CH07055A	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	04/01/2023
CH07055A	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2014
CH07055A	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2018
CH07055A	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2018
CH07055A	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		2/1/2022 12:00:00 AM	2/10/2022 8:25 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/10/2022 8:25 AM
Terminations	Termination Comments	Update	Recertification		administrative site only- never purchased 340B drugs	2/10/2022 8:25 AM
Terminations	Termination Date	Update	Recertification		4/1/2022 12:00:00 AM	2/10/2022 8:25 AM
Terminations	Termination Effective Date	Update	Recertification		2/1/2022 12:00:00 AM	2/10/2022 8:25 AM
Terminations	Termination Reason	Update	Recertification		Other	2/10/2022 8:25 AM
Addresses	Shipping Address	Delete	Recertification	Primary Health Care,Inc. 1200 University Ave 105 Des Moines, IA 50314		2/8/2021 9:03 AM
Addresses	Shipping Address	Insert	Recertification		Primary Health Care Pharmacy 1200 University Ave 105 Des Moines, IA 50314	2/8/2021 9:03 AM
Details	Last Recertification Date	Update	Recertification	2/18/2020 8:06:30 AM	2/8/2021 9:03:29 AM	2/8/2021 9:03 AM
Addresses	Billing Address	Insert	Recertification		Primary Health Care, Inc. 1200 University Ave 200 Des Moines, IA 50314	2/18/2020 8:06 AM
Addresses	Shipping Address	Insert	Recertification		Primary Health Care,Inc. 1200 University Ave 105 Des Moines, IA 50314	2/18/2020 8:06 AM
Addresses	Main Address	Update	Recertification	1200 University Ave., Suite 110A Des Moines, IA 50314-2343	1200 University Ave. 110A Des Moines, IA 50314-2343	2/18/2020 8:06 AM
Details	Last Recertification Date	Update	Recertification	2/4/2019 11:59:46 AM	2/18/2020 8:06:30 AM	2/18/2020 8:06 AM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/18/2020 8:06 AM
Details	Last Recertification Date	Update	Recertification	2/22/2018 10:39:45 AM	2/4/2019 11:59:46 AM	2/4/2019 11:59 AM
Details	Last Recertification Date	Update	Recertification	2/13/2017 12:00:00 AM	2/22/2018 10:39:45 AM	2/22/2018 10:39 AM
Contacts	Authorizing Official	Update	New Registration	Huntsman, Kelly CEO 5152481441	Huntsman, Kelly CEO Primary Health Care 5152481441	10/5/2017 4:10 PM
Contacts	Signed By	Update	New Registration	Huntsman, Kelly CEO 5152481441	Huntsman, Kelly CEO Primary Health Care 5152481441	10/5/2017 4:10 PM
Contacts	Primary Contact	Update		Price-Eastman, Heidi Pharmacy Director 5152481558	Price-Eastman, Heidi Pharmacy Director Primary Health Care 5152481558	9/29/2017 9:08 AM
Contacts	Primary Contact	Insert			Price-Eastman, Heidi Pharmacy Director 5152481558	7/13/2017 5:04 PM
Contacts	Authorizing Official	Insert			Huntsman, Kelly CEO 5152481441	7/13/2017 5:04 PM
Contacts	Signed By	Insert			Huntsman, Kelly CEO 5152481441	7/13/2017 5:04 PM
Addresses	Main Address	Insert			1200 University Ave., Suite 110A Des Moines, IA 50314-2343	2/13/2017 11:51 AM
Details	Last Recertification Date	Update			2/13/2017 12:00:00 AM	2/13/2017 11:51 AM
Dates	Participating Approval Date	Update			10/24/2016 12:00:00 AM	10/24/2016 3:02 PM
Details	State	Update		Pending	Active	10/24/2016 3:02 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	10/24/2016 3:02 PM
Details	340B ID	Update		ONLINE_REG_72706	CH07055AG	10/19/2016 11:59 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_72706	10/7/2016 5:15 PM
Details	Last Recertification Date	Insert				10/7/2016 5:15 PM
Details	Grant Number	Insert			H80CS00715	10/7/2016 5:15 PM
Details	340B ID	Insert			ONLINE_REG	10/7/2016 5:15 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/7/2016 5:15 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/7/2016 5:15 PM
Details	Medicare Provider Number	Insert				10/7/2016 5:15 PM
Details	Entity Name	Insert			PRIMARY HEALTH CARE INC	10/7/2016 5:15 PM
Details	Program Code	Insert			CH	10/7/2016 5:15 PM
Details	Entity Subname	Insert			Primary Health Care, Inc. - Homeless Advocacy Program	10/7/2016 5:15 PM
Dates	Participating Approval Date	Insert				10/7/2016 5:15 PM
Details	State	Insert			Pending	10/7/2016 5:15 PM
Dates	Registration Date	Insert			10/7/2016 12:00:00 AM	10/7/2016 5:15 PM
Dates	Signed By Date	Insert			10/7/2016 12:00:00 AM	10/7/2016 5:15 PM
Dates	Start Date	Insert				10/7/2016 5:15 PM
Terminations	Termination Comments	Insert				10/7/2016 5:15 PM
Terminations	Termination Date	Insert				10/7/2016 5:15 PM
Terminations	Termination Effective Date	Insert				10/7/2016 5:15 PM
Terminations	Termination Reason	Insert				10/7/2016 5:15 PM

340B Drug Pricing Program Database