Covered Entity Details

CH05213J CHRISTOPHER RURAL HEALTH PLANNING CORP. (Terminated) - information as of 6/3/2025 12:05:40 PM

Main Details

Name

CHRISTOPHER RURAL HEALTH PLANNING CORP.

Subdivision Name

REA DENTAL CLINIC

Type

HRSA-Funded Health Center

Site ID

BPS-H80-005649

340B ID

CH05213J

Grant Number

H80CS00726

Additional Details

Current Program Status

Terminated

Registration Date

10/1/1998

Participating Start Date

10/1/1998

Participating Approval Date

2/25/2004

Last Recertification Date

2/4/2022

Termination Date
Termination Reason

4/1/2022
Other

Contacts

Authorizing Official

Christopher Rural Health Planning Corporation
KIMBERLY A. MITROKA, PRESIDENT/CEO
(618) 724-2436 Ext: 1602

Primary Contact

Christopher (Greater Area) Rural Health Planning Corporation
SALLY A. CESAR, EXECUTIVE VP
(618) 724-2436 Ext: 241

Addresses

Street Address

4241 HIGHWAY 14 WEST
CHRISTOPHER, IL 62822

Billing Address

CHRISTOPHER RURAL HEALTH PLANNING CORP.
PO BOX 155
CHRISTOPHER, IL 62822

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

Comments

Comment	Last Updated On
NEW CONTACT, ADDED FAX, ONLY BILL TO ADDRESS	08/12/2005

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
IL	371041283008	1780739300

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
CH052130	Active	BPS-H80-003564	CHRISTOPHER RURAL HEALTH PLANNING CORP.	REA CLINIC	4241 HWY 14 WEST	CHRISTOPHER	IL
CH05213A	Active	BPS-H80-029688	CHRISTOPHER RURAL HEALTH PLANNING CORP.	CLAY MEDICAL CENTER	165 Kinnaman Drive	FLORA	IL
CH05213AA	Active	BPS-H80-034173	Christopher Greater Area Rural Health Planning Corporation	CRHPC Comprehensive Behavioral Health Center	119 Gas Plant Rd	Du Quoin	IL
CH05213AB	Active	BPS-H80-035230	Christopher Greater Area Rural Health Planning Corporation	Carrier Mills Community Health Center	7211 US 45 S	Carrier Mills	IL
CH05213AC	Active	BPS-H80-038802	Christopher Greater Area Rural Health Planning Corporation	Benton Mental Health Wellness Center	107 East Smith Street STE B	Benton	IL
CH05213B	Active	BPS-H80-010057	CHRISTOPHER RURAL HEALTH PLANNING CORP	Sesser Community Health Center	6294 State Highway 154	Sesser	IL
CH05213I	Active	BPS-H80-004248	CHRISTOPHER RURAL HEALTH PLANNING CORP	MT VERNON COMMUNITY HLTH CENTER	2920 VETERAN'S PKWY	MT VERNON	IL
CH05213J	Terminated	BPS-H80-005649	CHRISTOPHER RURAL HEALTH PLANNING CORP.	REA DENTAL CLINIC	4241 HIGHWAY 14 WEST	CHRISTOPHER	IL
CH05213L	Terminated	BPS-H80-002415	CHRISTOPHER RURAL HEALTH PLANNING CORP	REA CLINIC-DUQUOIN FACILITY	119 Gas Plant Rd	Du Quoin	IL
CH05213L1	Active	BPS-H80-008067	CHRISTOPHER RURAL HEALTH PLANNING CORP.	JOHNSTON CITY COMMUNITY HEALTH CENTER	14410 IL-37	JOHNSTON CITY	IL
CH05213M	Active	BPS-H80-009146	CHRISTOPHER RURAL HEALTH PLANNING CORP.	SHAWNEETOWN HEALTH CARE CENTER	9525 Gold Hill Road	Shawneetown	IL
CH05213N	Terminated	BPS-H80-003132	CHRISTOPHER RURAL HEALTH PLANNING CORP	REA CLINIC-HERRIN	3303 Logan Dr	Herrin	IL
CH05213O	Terminated	BPS-H80-002573	CHRISTOPHER RURAL HEALTH PLANNING CORP.	ROYALTON COMMUNITY HEALTH CENTER	300 SOUTH MAIN	ROYALTON	IL
CH05213P	Terminated	BPS-H80-005294	CHRISTOPHER RURAL HEALTH PLANNING CORP	ZEIGLER COMMUNITY HEALTH CTR	27 Circle St	Zeigler	IL
CH05213R	Terminated	BPS-H80-002116	CHRISTOPHER RURAL HEALTH PLANNING CORP	HAMILTON COUNTY HEALTH CENTER	613 S Marshall Ave	Mc Leansboro	IL
CH05213S	Terminated	BPS-H80-002876	CHRISTOPHER RURAL HEALTH PLANNING CORP.	CISNE MEDICAL CENTER	RAILROAD AND PARK STREET	CISNE	IL
CH05213T	Terminated	BPS-H80-000937	CHRISTOPHER RURAL HEALTH PLANNING CORP	REA CLINIC-BENTON	201 Bailey Ln	Benton	IL
CH05213U	Active	BPS-H80-012565	CHRISTOPHER RURAL HEALTH PLANNING CORP	Eldorado Rural Health Clinic	1401 US-45 North	Eldorado	IL
CH05213V	Active	BPS-H80-038330	CHRISTOPHER RURAL HEALTH PLANNING CORP	Fairfield Community Health Center	1007 W Main St	Fairfield	IL
CH05213W	Active	BPS-H80-011076	CHRISTOPHER RURAL HEALTH PLANNING CORP	Albion Community Health Center	33 West Main Street	Albion	IL
CH05213X	Active	BPS-H80-011156	CHRISTOPHER RURAL HEALTH PLANNING CORP	CRHPC-Carmi Health Center	103 Commerce Street	Carmi	IL
CH05213Y	Active	BPS-H80-018327	Christopher Rural Health Planning Corp	Rea Clinic - Du Quoin	1564 South Washington Street	Du Quoin	IL
CH05213Z	Active	BPS-H80-031530	Christopher Rural Health Planning Corp	Rea Clinic - Benton	206 E Church St Ste B	Benton	IL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH05213L1	BANDY DRUGS	905 GRAND AVE		JOHNSTON CITY	IL	62951-1219	05/05/2010	04/05/2017
CH052130	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2024
CH052130	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2024
CH052130	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2024
CH052130	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2024
CH052130	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2024
CH052130	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2024
CH052130	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2024
CH052130	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2024
CH052130	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH052130	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2024
CH052130	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2023
CH052130	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2023
CH052130	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2024
CH052130	EDS MEDICENTER PHARMACY	SESSER PHARMACY SI LLC	1116 W MAIN ST	FAIRFIELD	IL	62837-2324	04/01/2018	09/23/2020
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06885	700 W. MAIN ST.	FAIRFIELD	IL	62837	10/01/2018
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06385	1301 N. STATE ST.	FLORA	IL	62839	10/01/2018
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06372	705 WEST MAINST.	BENTON	IL	62812	10/01/2018
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06887	915 N. MARKET ST.	MOUNT CARMEL	IL	62863	10/01/2018
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06886	1101 W. MAIN ST.	CARMI	IL	62821	10/01/2018
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06373	304 W. MAIN ST.	WEST FRANKFORT	IL	62896	10/01/2018
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06388	801 W. MAIN ST.	MARION	IL	62959	10/01/2018
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06370	2700 BROADWAY	MOUNT VERNON	IL	62864	01/01/2019
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 03188	ONE SOUTH COMMERCIAL STREET	HARRISBURG	IL	62946	01/01/2019
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06371	914 W. MAIN ST.	OLNEY	IL	62450	01/01/2019
CH052130	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06390	2431 W. MAIN ST.	CARBONDALE	IL	62901	04/01/2023
CH05213N	LOGAN PRIMARY PHARMACY	401 RUSHING DR		HERRIN	IL	62948	05/06/2010	10/01/2016
CH052130	MEDICENTER PHARMACY	SESSER PHARMACY SI LLC	6294 STATE HIGHWAY 154 SUITE A	SESSER	IL	62884-2163	04/01/2018	06/30/2021
CH052130	MEDICENTER PHARMACY DUQUOIN	TOWN & COUNTRY PHARMACIES, INC.	204 S WASHINGTON ST.	DU QUOIN	IL	62832-1805	04/01/2015
CH05213L	MEDICENTER PHARMACY DUQUOIN	TOWN & COUNTRY PHARMACIES, INC.	204 S WASHINGTON ST.	DU QUOIN	IL	62832-1805	04/16/2010	04/01/2019
CH052130	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2024
CH052130	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2024
CH052130	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2024
CH052130	THE MEDICINE SHOPPE	EDLUCY, INC.	1116 WEST MAIN STREET	FAIRFIELD	IL	62837	04/01/2015	01/03/2017
CH052130	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH052130	WAL-MART PHARMACY 10-0224	110 DAVIDSON AVENUE		MOUNT VERNON	IL	62864	10/01/2022
CH052130	WAL-MART PHARMACY 10-0237	710 SOUTH COMMERCIAL		HARRISBURG	IL	62946	04/01/2015
CH052130	WAL-MART PHARMACY 10-0252	215 GRANT WAY		DU QUOIN	IL	62832	04/01/2015
CH052130	WAL-MART PHARMACY 10-0262	919 GIACONE DR		BENTON	IL	62812	04/01/2015
CH052130	WAL-MART PHARMACY 10-0454	150 COMMERCE DR.		FAIRFIELD	IL	62837	01/01/2015
CH052130	WAL-MART PHARMACY 10-0506	1540 N WORTHY		FLORA	IL	62839	04/01/2016
CH052130	WAL-MART PHARMACY 10-0833	1344 ILLINOIS HWY #1		CARMI	IL	62821	01/01/2015
CH052130	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH052130	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH052130	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

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	Termination Request		2/10/2022 12:00:00 AM	2/11/2022 8:03 AM
Details	State	Update	Termination Request	Active	To Be Terminated	2/11/2022 8:03 AM
Terminations	Termination Comments	Update	Termination Request		Rea Dental Clinic is location within the 4 walls of 340B ID CH52130. Christopher Rea Clinic	2/11/2022 8:03 AM
Terminations	Termination Date	Update	Termination Request		4/1/2022 12:00:00 AM	2/11/2022 8:03 AM
Terminations	Termination Effective Date	Update	Termination Request		2/10/2022 12:00:00 AM	2/11/2022 8:03 AM
Terminations	Termination Reason	Update	Termination Request		Other	2/11/2022 8:03 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 11:22:14 AM	2/4/2022 4:05:43 PM	2/4/2022 4:05 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780739300	2/4/2021 11:22 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	2/4/2021 11:22 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1780739300 ( )		2/4/2021 11:22 AM
Details	Last Recertification Date	Update	Recertification	2/6/2020 12:40:18 PM	2/4/2021 11:22:14 AM	2/4/2021 11:22 AM
Details	Last Recertification Date	Update	Recertification	2/1/2019 11:15:30 AM	2/6/2020 12:40:18 PM	2/6/2020 12:40 PM
Details	Last Recertification Date	Update	Recertification	2/9/2018 11:08:12 AM	2/1/2019 11:15:30 AM	2/1/2019 11:15 AM
Contacts	Primary Contact	Update	Recertification	CESAR, SALLY A. EXEC. VICE PRESIDENT 6187241605	CESAR, SALLY A. EXECUTIVE VP Christopher (Greater Area) Rural Health Planning Corporation 6187242436-241	2/9/2018 11:08 AM
Details	Last Recertification Date	Update	Recertification	2/2/2017 12:00:00 AM	2/9/2018 11:08:12 AM	2/9/2018 11:08 AM
Contacts	Authorizing Official	Insert	AO Change Request		MITROKA, KIMBERLY A. PRESIDENT/CEO Christopher Rural Health Planning Corporation 6187242436-1602	11/6/2017 9:38 AM
Addresses	Main Address	Insert			4241 HIGHWAY 14 WEST CHRISTOPHER, IL 62822	2/2/2017 11:23 AM
Contacts	Primary Contact	Insert			CESAR, SALLY A. EXEC. VICE PRESIDENT 6187241605	2/2/2017 11:23 AM
Medicaid Billing	NPI: Number	Insert			1780739300	2/2/2017 11:23 AM
Details	Last Recertification Date	Update		2/15/2016 12:00:00 AM	2/2/2017 12:00:00 AM	2/2/2017 11:23 AM
Details	Last Recertification Date	Update		2/11/2015 12:00:00 AM	2/15/2016 12:00:00 AM	3/2/2016 12:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/11/2015 10:16 AM
Medicaid Billing	Medicaid: Number	Insert			371041283008	2/11/2015 10:16 AM
Medicaid Billing	Medicaid: State	Insert			IL	2/11/2015 10:16 AM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	2/11/2015 12:00:00 AM	2/11/2015 10:16 AM
Addresses	Billing Address	Insert			CHRISTOPHER RURAL HEALTH PLANNING CORP. PO BOX 155 CHRISTOPHER, IL 62822	3/24/2014 11:13 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/10/2014 12:00:00 AM	2/10/2014 9:50 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/7/2013 10:25 AM
Details	Last Recertification Date	Insert				8/12/2005 2:24 PM
Details	Grant Number	Insert			H80CS00726	8/12/2005 2:24 PM
Details	340B ID	Insert			CH05213J	8/12/2005 2:24 PM
Details	Is Authorizing Official EHB Data	Insert				8/12/2005 2:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/12/2005 2:24 PM
Details	Medicare Provider Number	Insert				8/12/2005 2:24 PM
Details	Entity Name	Insert			CHRISTOPHER RURAL HEALTH PLANNING CORP.	8/12/2005 2:24 PM
Details	Program Code	Insert			CH	8/12/2005 2:24 PM
Details	Entity Subname	Insert			REA DENTAL CLINIC	8/12/2005 2:24 PM
Dates	Participating Approval Date	Insert			2/25/2004 12:00:00 AM	8/12/2005 2:24 PM
Details	State	Insert			Active	8/12/2005 2:24 PM
Dates	Registration Date	Insert			10/1/1998 12:00:00 AM	8/12/2005 2:24 PM
Dates	Signed By Date	Insert				8/12/2005 2:24 PM
Dates	Start Date	Insert			10/1/1998 12:00:00 AM	8/12/2005 2:24 PM
Terminations	Termination Comments	Insert				8/12/2005 2:24 PM
Terminations	Termination Date	Insert				8/12/2005 2:24 PM
Terminations	Termination Effective Date	Insert				8/12/2005 2:24 PM
Terminations	Termination Reason	Insert				8/12/2005 2:24 PM
Details	Comments Public	Insert			NEW CONTACT, ADDED FAX, ONLY BILL TO ADDRESS	8/12/2005 2:24 PM

340B Drug Pricing Program Database