Covered Entity Details

CH07117AA Community Health Care, Inc. (Active) - information as of 5/5/2025 10:10:29 PM

Main Details

Name

Community Health Care, Inc.

Subdivision Name

Community Health Care, Inc. Muscatine

Type

HRSA-Funded Health Center

Site ID

BPS-H80-033697

340B ID

CH07117AA

Grant Number

H80CS00670

Additional Details

Current Program Status

Active

Registration Date

4/14/2020

Participating Start Date

5/15/2020

Participating Approval Date

4/21/2020

Last Recertification Date

2/14/2025

Contacts

Authorizing Official

Community Health Care Inc
Tom Bowman, CEO
(563) 336-3000 Ext: 3112

Primary Contact

Community Health Care, Inc.
Sarah Brondyke, Pharmacy Coordinator
(563) 336-3059

Addresses

Street Address

2925 Cedar St
Ste 2
Muscatine, IA 52761

Billing Address

Community Health Care Inc
500 W River Dr
Davenport, IA 52801

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?
Yes

State	Medicaid Number	NPI Number
IA	1326680067	1326680067
IL	421060724018	1326680067

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
Contract Detail	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08656	2617 18TH AVE.	ROCK ISLAND	IL	61201	07/11/2024	10/01/2024			10/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05885	1703 PARK AVE	MUSCATINE	IA	52761	01/17/2023	04/01/2023			04/01/2023

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH071170	Active	BPS-H80-004273	COMMUNITY HEALTH CARE, INC.	Community Health Care, Inc. River Drive Clinic	500 W River Dr	Davenport	IA
CH07117A	Active	BPS-H80-008204	COMMUNITY HEALTH CARE, INC.	Community Health Care, Inc. Moline	1106 4th Avenue	Moline	IL
CH07117AA	Active	BPS-H80-033697	Community Health Care, Inc.	Community Health Care, Inc. Muscatine	2925 Cedar St	Muscatine	IA
CH07117AB	Active	BPS-H80-037807	Community Health Care, Inc.	Community Health Care, Inc. - The Project	4101 John Deere Rd	Moline	IL
CH07117AC	Terminated	BPS-H80-037332	COMMUNITY HEALTH CARE, INC.	Humility	530 Vine St	Davenport	IA
CH07117AD	Active	BPS-H80-038438	COMMUNITY HEALTH CARE, INC.	Community Health Care Inc. Outreach Clinic	902 W 4th St	Davenport	IA
CH07117B	Active	BPS-H80-003939	COMMUNITY HEALTH CARE, INC.	Community Health Care Inc. Dental Clinic	125 Scott St	Davenport	IA
CH07117D	Terminated	BPS-H80-006060	COMMUNITY HEALTH CARE, INC.	Adult Rehabilitation Center	4001 N Brady St	Davenport	IA
CH07117F	Terminated	BPS-H80-006812	COMMUNITY HEALTH CARE, INC.	Community Health Care, Inc. Iowa Homeless Drop-In Clinic	303 W 6th St	Davenport	IA
CH07117G	Active	BPS-H80-000222	COMMUNITY HEALTH CARE, INC.	Community Health Care, Inc. Rock Island Clinic	2750 11th St	Rock Island	IL
CH07117H	Terminated	BPS-H80-009125	COMMUNITY HEALTH CARE, INC.	Illinois Drop-In MLK Center - Homeless	630 9th St	Rock Island	IL
CH07117V	Active	BPS-H80-012284	COMMUNITY HEALTH CARE, INC.	Community Health Care, Inc. East Moline Clinic	708 15th Ave	East Moline	IL
CH07117W	Active	BPS-H80-009584	COMMUNITY HEALTH CARE, INC.	Community Health Care, Inc. - Robert Young Center	2200 3rd Ave	Rock Island	IL
CH07117X	Active	BPS-H80-015375	COMMUNITY HEALTH CARE, INC.	Community Health Care Inc. Clinton Clinic	925 S 4th St	Clinton	IA
CH07117Y	Active	BPS-H80-017681	COMMUNITY HEALTH CARE, INC.	Edgerton Women's Health Center	1510 E Rusholme St	Davenport	IA
CH07117Z	Active	BPS-H80-029818	Community Health Care, Inc.	Community Health Care, Inc. MCSA Muscatine	312 Iowa Ave	Muscatine	IA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH071170	AMERICAN DRUG STORES LLC	OSCO DRUG 1118	1309 N 2ND ST	CLINTON	IA	52732	04/01/2021
CH071170	AMERICAN DRUG STORES LLC	DBA OSCO DRUG 3088	1312 JOHN DEERE EXPWY	SILVIS	IL	61282	04/01/2021
CH071170	AMERICAN DRUG STORES LLC	DBA OSCO DRUG 3770	107 AVENUE OF THE CITIES	EAST MOLINE	IL	61244	04/01/2021
CH071170	AMERICAN DRUG STORES LLC	DBA OSCO DRUG 122	2010 1ST ST STE A	MOLINE	IL	61265	10/01/2023	10/09/2024
CH071170	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/01/2019
CH071170	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	10/01/2019
CH071170	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03991	3100 11TH ST	ROCK ISLAND	IL	61201	05/11/2012	03/29/2023
CH071170	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04332	2955 18TH AVE.	ROCK ISLAND	IL	61201	05/11/2012
CH071170	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04333	301 30TH AVE.	EAST MOLINE	IL	61244	05/11/2012
CH07117W	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04332	2955 18TH AVE.	ROCK ISLAND	IL	61201	10/01/2023
CH071170	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2024
CH071170	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	10/01/2019
CH071170	EXACT CARE PHARMACY	DDCRX, LLC	2701 HIGHPOINT OAKS DR STE 100	LEWISVILLE	TX	75067-3896	10/01/2021	03/31/2024
CH071170	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	10/01/2021	03/31/2024
CH071170	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08656	2617 18TH AVE.	ROCK ISLAND	IL	61201	10/01/2018
CH071170	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 00484	2250 41ST ST.	MOLINE	IL	61265	10/01/2019	11/29/2023
CH071170	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08634	910 W. 4TH ST.	MILAN	IL	61264	10/01/2019
CH071170	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16348	900 42ND AVENUE DR	MOLINE	IL	61265	04/01/2023
CH07117AA	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08656	2617 18TH AVE.	ROCK ISLAND	IL	61201	10/01/2024
CH07117Z	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 00484	2250 41ST ST.	MOLINE	IL	61265	10/01/2024	07/15/2024
CH071170	HY-VEE DRUGSTORE PHCY #7060	510 EAST 6TH STREET		MUSCATINE	IA	52761	10/01/2020
CH071170	HY-VEE FOOD STORES	DBA HY-VEE FOOD STORE#1	3019 ROCKINGHAM RD	DAVENPORT	IA	52802	04/01/2019	10/09/2024
CH071170	HY-VEE PHARMACY	2001 5TH ST		SILVIS	IL	61282	04/01/2019
CH071170	HY-VEE PHARMACY #5 (1109)	2351 W LOCUST		DAVENPORT	IA	52804	10/01/2020
CH071170	HY-VEE PHARMACY (1075)	901 SOUTH 4TH ST		CLINTON	IA	52732	04/01/2019
CH07117X	HY-VEE PHARMACY (1075)	901 SOUTH 4TH ST		CLINTON	IA	52732	04/01/2023
CH071170	HY-VEE PHARMACY (1415)	201 WEST 10TH AVENUE		MILAN	IL	61264	10/01/2020
CH071170	HY-VEE PHARMACY (1416)	4218 AVENUE OF THE CITIES		MOLINE	IL	61265	10/01/2020
CH071170	Hy-Vee Pharmacy Fulfillment Center #4016	Hy-Vee Inc	4707 Fleur Dr	Des Moines	IA	50321	04/01/2019
CH071170	HY-VEE PHCY	1823 E KIMBERLY		DAVENPORT	IA	52807	10/01/2020
CH071170	HY-VEE PHRM CLINIC 1549	2930 18TH AVE		ROCK ISLAND	IL	61201	04/01/2019
CH07117W	HY-VEE PHRM CLINIC 1549	2930 18TH AVE		ROCK ISLAND	IL	61201	04/01/2023
CH071170	IOWA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08659	1777 DIVISION ST.	DAVENPORT	IA	52804	01/01/2019	12/07/2023
CH071170	IOWA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08658	1655 WEST KIMBERLY ROAD	DAVENPORT	IA	52806	10/01/2019	11/07/2023
CH071170	IOWA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 08658	1655 WEST KIMBERLY ROAD	DAVENPORT	IA	52806	07/31/2024
CH071170	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/01/2019
CH071170	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	10/01/2019
CH071170	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2018
CH071170	WAL-MART PHARMACY 10-0559	3003 N HIGHWAY 61		MUSCATINE	IA	52761	04/01/2021
CH071170	WAL-MART PHARMACY 10-1241	5811 ELMORE AVENUE		DAVENPORT	IA	52807	10/01/2018
CH071170	WAL-MART PHARMACY 10-1509	103 E. CARLISLE		MAQUOKETA	IA	52060	04/01/2021
CH071170	WAL-MART PHARMACY 10-2231	3930 44TH AVENUE DRIVE		MOLINE	IL	61265	10/01/2018
CH071170	WAL-MART PHARMACY 10-2889	2715 SO. 25TH STREET		CLINTON	IA	52732	10/01/2018
CH07117AD	WAL-MART PHARMACY 10-2889	2715 SO. 25TH STREET		CLINTON	IA	52732	10/01/2024
CH071170	WAL-MART PHARMACY 10-4511	1601 18TH STREET		SILVIS	IL	61282	10/01/2018
CH071170	WAL-MART PHARMACY 10-5115	3101 W KIMBERLY RD		DAVENPORT (W)	IA	52806	10/01/2018
CH071170	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2018
CH071170	WAL-MART PHARMACY WHSE #45	2250 NORTH 8TH STREET	SUITE 102-A	ROGERS	AR	72756	07/01/2023	04/05/2024
CH071170	Walgreen CO	DBA Walgreens Central Fill #21417	599 S Schmidt Rd Ste A	Bolingbrook	IL	60440-9405	04/01/2023
CH071170	WALGREEN CO.	DBA: WALGREENS # 03633	4000 AVENUE OF THE CITIES	MOLINE	IL	61265	09/21/2011
CH071170	WALGREEN CO.	DBA: WALGREENS # 03595	1720 W. KIMBERLY RD.	DAVENPORT	IA	52806	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 04041	1525 E KIMBERLY RD	DAVENPORT	IA	52807	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 09515	1301 AVENUE OF THE CITIES	EAST MOLINE	IL	61244	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 05239	1660 W LOCUST ST	DAVENPORT	IA	52804	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 05512	3425 MIDDLE ROAD	BETTENDORF	IA	52722	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 05720	3601 16TH ST	MOLINE	IL	61265	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 05885	1703 PARK AVE	MUSCATINE	IA	52761	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 06067	555 19TH AVE	MOLINE	IL	61265-3761	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 06186	4011 E 53RD ST	DAVENPORT	IA	52807	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 06553	830 MIDDLE ROAD	BETTENDORF	IA	52722-4101	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 09267	440 W 10TH AVE	MILAN	IL	61264	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 11709	1805 BRADY ST	DAVENPORT	IA	52803	05/11/2012	04/03/2024
CH071170	WALGREEN CO.	DBA: WALGREENS #11881	600 N MAIN ST	MONMOUTH	IL	61462	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS #12305	1009 S OAKWOOD AVE	GENESEO	IL	61254-1937	05/11/2012
CH071170	WALGREEN CO.	DBA: WALGREENS # 05119	806 S. 4TH ST	CLINTON	IA	52732	04/01/2016
CH07117AA	WALGREEN CO.	DBA: WALGREENS # 05885	1703 PARK AVE	MUSCATINE	IA	52761	04/01/2023
CH07117A	WALGREEN CO.	DBA: WALGREENS # 03633	4000 AVENUE OF THE CITIES	MOLINE	IL	61265	10/01/2023
CH07117Y	WALGREEN CO.	DBA: WALGREENS # 04041	1525 E KIMBERLY RD	DAVENPORT	IA	52807	10/01/2023
CH07117V	WALGREEN CO.	DBA: WALGREENS # 09515	1301 AVENUE OF THE CITIES	EAST MOLINE	IL	61244	10/01/2023
CH07117X	WALGREEN CO.	DBA: WALGREENS # 05119	806 S. 4TH ST	CLINTON	IA	52732	10/01/2023
CH07117B	WALGREEN CO.	DBA: WALGREENS # 05239	1660 W LOCUST ST	DAVENPORT	IA	52804	10/01/2023
CH07117AB	WALGREEN CO.	DBA: WALGREENS # 06067	555 19TH AVE	MOLINE	IL	61265-3761	10/01/2023
CH071170	WALGREEN CO.	DBA: WALGREENS # 05144	1905 N 2ND ST	CLINTON	IA	52732	07/01/2024
CH07117Y	WALGREEN CO.	DBA: WALGREENS # 03633	4000 AVENUE OF THE CITIES	MOLINE	IL	61265	10/01/2024
CH07117Z	WALGREEN CO.	DBA: WALGREENS # 04041	1525 E KIMBERLY RD	DAVENPORT	IA	52807	04/01/2025
CH071170	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2013	07/06/2015
CH071170	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2024
CH071170	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2024
CH071170	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2024
CH071170	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2024
CH071170	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Recertification	2925 Cedar St Suite 2 Muscatine, IA 52761-2385	2925 Cedar St Ste 2 Muscatine, IA 52761	2/14/2025 6:43 AM
Details	Last Recertification Date	Update	Recertification	2/7/2024 5:07:46 PM	2/14/2025 6:43:56 AM	2/14/2025 6:43 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 12:39:20 PM	2/7/2024 5:07:46 PM	2/7/2024 5:07 PM
Contacts	Authorizing Official	Update	AO Change Request	Bowman, Thomas CEO Community Health Care, Inc. 5633363112	Bowman, Tom CEO Community Health Care Inc 5633363000-3112	11/9/2023 1:10 PM
Details	Last Recertification Date	Update	Recertification	2/7/2022 5:56:41 PM	1/31/2023 12:39:20 PM	1/31/2023 12:39 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/7/2022 5:56 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		421060724018	2/7/2022 5:56 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	2/7/2022 5:56 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326680067	2/7/2022 5:56 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	2/7/2022 5:56 PM
Details	Last Recertification Date	Update	Recertification	2/4/2021 9:03:16 AM	2/7/2022 5:56:41 PM	2/7/2022 5:56 PM
Addresses	Main Address	Update	Change Request	1616 Cedar St Muscatine, IA 52761-3453	2925 Cedar St Suite 2 Muscatine, IA 52761-2385	12/8/2021 11:40 AM
Medicaid Billing	NPI: State	Update	Recertification		IA	2/4/2021 9:03 AM
Details	Last Recertification Date	Update	Recertification		2/4/2021 9:03:16 AM	2/4/2021 9:03 AM
Contacts	Primary Contact	Update	Change Request	LOBB, TIM Pharmacist in Charge Community Health Care, Inc. 5633363181	Brondyke, Sarah Pharmacy Coordinator Community Health Care, Inc. 5633363059	1/29/2021 9:13 AM
Details	State	Update	OPA Edit	Approved	Active	5/15/2020 5:03 PM
Dates	Start Date	Update	OPA Edit	7/1/2020 12:00:00 AM	5/15/2020 12:00:00 AM	5/15/2020 5:03 PM
Contacts	Signed By	Insert	New Registration		Bowman, Thomas CEO Community Health Care, Inc. 5633363112	4/21/2020 9:58 AM
Details	340B ID	Update	New Registration		CH07117AA	4/21/2020 9:58 AM
Dates	Participating Approval Date	Update	New Registration		4/21/2020 9:58:03 AM	4/21/2020 9:58 AM
Details	State	Update	New Registration	Pending	Approved	4/21/2020 9:58 AM
Dates	Signed By Date	Update	New Registration		4/14/2020 1:36:57 PM	4/21/2020 9:58 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/21/2020 9:58 AM
Addresses	Main Address	Insert	New Registration		1616 Cedar St Muscatine, IA 52761-3453	4/14/2020 1:36 PM
Addresses	Billing Address	Insert	New Registration		Community Health Care Inc 500 W River Dr Davenport, IA 52801	4/14/2020 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/14/2020 1:36 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1326680067	4/14/2020 1:36 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	4/14/2020 1:36 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326680067	4/14/2020 1:36 PM
Contacts	Authorizing Official	Insert	New Registration		Bowman, Thomas CEO Community Health Care, Inc. 5633363112	4/14/2020 1:36 PM
Contacts	Primary Contact	Insert	New Registration		LOBB, TIM Pharmacist in Charge Community Health Care, Inc. 5633363181	4/14/2020 1:36 PM
Details	Last Recertification Date	Insert	New Registration			4/14/2020 1:36 PM
Details	Grant Number	Insert	New Registration		H80CS00670	4/14/2020 1:36 PM
Details	340B ID	Insert	New Registration			4/14/2020 1:36 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2020 1:36 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2020 1:36 PM
Details	Medicare Provider Number	Insert	New Registration			4/14/2020 1:36 PM
Details	Entity Name	Insert	New Registration		Community Health Care, Inc.	4/14/2020 1:36 PM
Details	Program Code	Insert	New Registration		CH	4/14/2020 1:36 PM
Details	Entity Subname	Insert	New Registration		Community Health Care, Inc. Muscatine	4/14/2020 1:36 PM
Dates	Participating Approval Date	Insert	New Registration			4/14/2020 1:36 PM
Details	State	Insert	New Registration		Pending	4/14/2020 1:36 PM
Dates	Registration Date	Insert	New Registration		4/14/2020 1:36:53 PM	4/14/2020 1:36 PM
Dates	Signed By Date	Insert	New Registration			4/14/2020 1:36 PM
Dates	Start Date	Insert	New Registration			4/14/2020 1:36 PM
Terminations	Termination Comments	Insert	New Registration			4/14/2020 1:36 PM
Terminations	Termination Date	Insert	New Registration			4/14/2020 1:36 PM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2020 1:36 PM
Terminations	Termination Reason	Insert	New Registration			4/14/2020 1:36 PM

340B Drug Pricing Program Database