Covered Entity Details

CH071243K Infinity Health (Terminated) - information as of 6/2/2025 8:28:34 AM

Main Details

Name

Infinity Health

Subdivision Name

Harrison County Community Hospital

Type

HRSA-Funded Health Center

Site ID

BPS-H80-029436

340B ID

CH071243K

Grant Number

H80CS04200

Additional Details

Current Program Status

Terminated

Registration Date

4/2/2020

Participating Start Date

7/1/2020

Participating Approval Date

5/1/2020

Last Recertification Date

2/5/2024

Termination Date
Termination Reason

4/1/2025
Site closure

Contacts

Authorizing Official

Infinity Health
Kyle Ahlenstorf, Chief Executive Officer
(641) 446-2383 Ext: 1250

Primary Contact

Infinity Health
Adam Dosch, Pharmacy Director
(641) 446-2383

Addresses

Street Address

2600 Miller St
Bethany, MO 64424-2701

Billing Address

Infinity Health
302 NE 14th Street
Leon, IA 50144-1206

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
CH0712430	Active	BPS-H80-002314	Infinity Health	Infinity Health	302 NE 14th St	Leon	IA
CH071243B	Active	BPS-H80-000967	Infinity Health	Infinity Health - Lamoni Office	802 Ackerly St	Lamoni	IA
CH071243C	Active	BPS-H80-020768	Infinity Health	CHARITON OFFICE	1711 Osceola Ave	Chariton	IA
CH071243D	Active	BPS-H80-018671	Infinity Health	Corydon	102-104 N Franklin	Corydon	IA
CH071243E	Active	BPS-H80-019572	Infinity Health	ALBIA OFFICE	117 South Main Street	Albia	IA
CH071243F	Active	BPS-H80-001057	Infinity Health	CHCSI Centerville	221 E State St	Centerville	IA
CH071243G	Active	BPS-H80-021911	Infinity Health	Princeton Office	606 W Main Street	Princeton	MO
CH071243H	Terminated	BPS-H80-027484	COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA, INC.	Chariton Medical Office	1030 N 7th St	Chariton	IA
CH071243J	Active	BPS-H80-030388	Infinity Health	Mount Ayr Office	119 S Fillmore St	Mount Ayr	IA
CH071243K	Terminated	BPS-H80-029436	Infinity Health	Harrison County Community Hospital	2600 Miller St	Bethany	MO
CH071243L	Active	BPS-H80-030312	Infinity Health	Osceola Office	219 W Washington	Osceola	IA
CH071243M	Active	BPS-H80-038972	INFINITY HEALTH	Osceola Dental	131 W Washington St	Osceola	IA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date
CH0712430	HY-VEE PHARMACY FULFILLMENT CENTER 4016	HY-VEE INC	4707 FLUER DR	DES MOINES	IA	50321	07/01/2014
CH071243B	HY-VEE PHARMACY FULFILLMENT CENTER 4016	HY-VEE INC	4707 FLUER DR	DES MOINES	IA	50321	07/01/2014
CH0712430	HY-VEE, INC.	DBA: HY-VEE CLINIC PHARMACY (1389)	204 N MAIN ST.	LEON	IA	50144	04/14/2014
CH071243B	HY-VEE, INC.	DBA: HY-VEE CLINIC PHARMACY (1376)	101 E MAIN	LAMONI	IA	50140	04/14/2014

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		4/1/2025 12:00:00 AM	3/3/2025 7:27 AM
Details	State	Update	Recertification	Active	To Be Terminated	3/3/2025 7:27 AM
Terminations	Termination Comments	Update	Recertification		No longer doing business at this site location.	3/3/2025 7:27 AM
Terminations	Termination Date	Update	Recertification		4/1/2025 12:00:00 AM	3/3/2025 7:27 AM
Terminations	Termination Effective Date	Update	Recertification		4/1/2025 12:00:00 AM	3/3/2025 7:27 AM
Terminations	Termination Reason	Update	Recertification		Site closure	3/3/2025 7:27 AM
Contacts	Primary Contact	Update	Change Request	Ahlenstorf, Kyle Chief Executive Officer Infinity Health 6414462383-1250	Dosch, Adam Pharmacy Director Infinity Health 6414462383	5/6/2024 1:23 PM
Contacts	Authorizing Official	Update	Change Request	Cannon, Samantha Chief Executive Officer Community Health Centers of Southern Iowa, Inc. 6414462383-1250	Ahlenstorf, Kyle Chief Executive Officer Infinity Health 6414462383-1250	5/6/2024 1:23 PM
Contacts	Primary Contact	Update	Recertification	Dosch, Adam Pharmacy Director Infinity Health 6414462383	Ahlenstorf, Kyle Chief Executive Officer Infinity Health 6414462383-1250	2/5/2024 6:38 AM
Details	Last Recertification Date	Update	Recertification	2/3/2023 5:48:45 PM	2/5/2024 6:38:35 AM	2/5/2024 6:38 AM
Details	Last Recertification Date	Update	Recertification	2/8/2022 5:19:18 PM	2/3/2023 5:48:45 PM	2/3/2023 5:48 PM
Addresses	Billing Address	Update	Recertification	Community Health Centers of Southern Iowa, Inc. 302 NE 14th Street Leon, IA 50144-1206	Infinity Health 302 NE 14th Street Leon, IA 50144-1206	2/8/2022 5:19 PM
Contacts	Primary Contact	Update	Recertification	Dosch, Adam Pharmacy Director Community Health Centers of Southern Iowa, Inc. 6414462383	Dosch, Adam Pharmacy Director Infinity Health 6414462383	2/8/2022 5:19 PM
Details	Last Recertification Date	Update	Recertification	2/10/2021 1:49:43 PM	2/8/2022 5:19:18 PM	2/8/2022 5:19 PM
Details	Entity Name	Update	Recertification	COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA, INC.	Infinity Health	2/8/2022 5:19 PM
Details	Last Recertification Date	Update	Recertification		2/10/2021 1:49:43 PM	2/10/2021 1:49 PM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		Cannon, Samantha Chief Executive Officer Community Health Centers of Southern Iowa, Inc. 6414462383-1250	5/1/2020 4:20 PM
Details	340B ID	Update	New Registration		CH071243K	5/1/2020 4:20 PM
Dates	Participating Approval Date	Update	New Registration		5/1/2020 4:20:00 PM	5/1/2020 4:20 PM
Details	State	Update	New Registration	Pending	Approved	5/1/2020 4:20 PM
Dates	Signed By Date	Update	New Registration		4/2/2020 12:47:58 AM	5/1/2020 4:20 PM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	5/1/2020 4:20 PM
Addresses	Main Address	Insert	New Registration		2600 Miller St Bethany, MO 64424-2701	4/2/2020 12:47 AM
Addresses	Billing Address	Insert	New Registration		Community Health Centers of Southern Iowa, Inc. 302 NE 14th Street Leon, IA 50144-1206	4/2/2020 12:47 AM
Contacts	Authorizing Official	Insert	New Registration		Cannon, Samantha Chief Executive Officer Community Health Centers of Southern Iowa, Inc. 6414462383-1250	4/2/2020 12:47 AM
Contacts	Primary Contact	Insert	New Registration		Dosch, Adam Pharmacy Director Community Health Centers of Southern Iowa, Inc. 6414462383	4/2/2020 12:47 AM
Details	Last Recertification Date	Insert	New Registration			4/2/2020 12:47 AM
Details	Grant Number	Insert	New Registration		H80CS04200	4/2/2020 12:47 AM
Details	340B ID	Insert	New Registration			4/2/2020 12:47 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/2/2020 12:47 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/2/2020 12:47 AM
Details	Medicare Provider Number	Insert	New Registration			4/2/2020 12:47 AM
Details	Entity Name	Insert	New Registration		COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA, INC.	4/2/2020 12:47 AM
Details	Program Code	Insert	New Registration		CH	4/2/2020 12:47 AM
Details	Entity Subname	Insert	New Registration		Harrison County Community Hospital	4/2/2020 12:47 AM
Dates	Participating Approval Date	Insert	New Registration			4/2/2020 12:47 AM
Details	State	Insert	New Registration		Pending	4/2/2020 12:47 AM
Dates	Registration Date	Insert	New Registration		4/2/2020 12:47:56 AM	4/2/2020 12:47 AM
Dates	Signed By Date	Insert	New Registration			4/2/2020 12:47 AM
Dates	Start Date	Insert	New Registration			4/2/2020 12:47 AM
Terminations	Termination Comments	Insert	New Registration			4/2/2020 12:47 AM
Terminations	Termination Date	Insert	New Registration			4/2/2020 12:47 AM
Terminations	Termination Effective Date	Insert	New Registration			4/2/2020 12:47 AM
Terminations	Termination Reason	Insert	New Registration			4/2/2020 12:47 AM

340B Drug Pricing Program Database