Covered Entity Details

CH10016AK Community Health Clinics, Inc. (Terminated) - information as of 5/9/2025 10:42:47 PM

Main Details

Name

Community Health Clinics, Inc.

Subdivision Name

Caldwell Dental

Type

HRSA-Funded Health Center

Site ID

BPS-H80-030393

340B ID

CH10016AK

Grant Number

H80CS00636

Additional Details

Current Program Status

Terminated

Registration Date

4/14/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/21/2020

Last Recertification Date

Termination Date
Termination Reason

4/1/2021
Site closure

Contacts

Authorizing Official

Terry Reilly Health Services
Heidi Hart, CEO
(208) 318-1255

Primary Contact

Community Health Clinics, Inc
Hollister A Henggeler, Pharmacy Director
(208) 318-1315

Addresses

Street Address

1916 Ellis Ave
Caldwell, ID 83605-4811

Billing Address

Community Health Clinics Inc
211 16th Avenue North
PO Box 9
Nampa, ID 83653

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
		1477560654

Shipping Addresses

Shipping Address 1

Community Health Clinics, Inc
207 1st Street South
Nampa, ID 83651

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
CH100160	Active	BPS-H80-003250	COMMUNITY HEALTH CLINICS, INC.	TERRY REILLY HEALTH SERVICES	211 16th Ave N	Nampa	ID
CH10016A	Active	BPS-H80-013568	COMMUNITY HEALTH CLINICS, INC.	Terry Reilly Nampa Clinic	207 1st Street South	Nampa	ID
CH10016AA	Active	BPS-H80-001972	COMMUNITY HEALTH CLINICS, INC.	Terry Reilly Latah Clinic	848 LA CASSIA DR	BOISE	ID
CH10016AB	Active	BPS-H80-005258	COMMUNITY HEALTH CLINICS, INC.	TERRY REILLY NAMPA CLINIC 3	207 16TH AVE, N.	NAMPA	ID
CH10016AC	Active	BPS-H80-002349	COMMUNITY HEALTH CLINICS, INC.	TERRY REILLY HLTH SVCS -NAMPA CLINIC	223 16th Ave N	Nampa	ID
CH10016AD	Active	BPS-H80-004053	COMMUNITY HEALTH CLINICS, INC.	CANYON DENTAL	11136 Moss Ln	Nampa	ID
CH10016AE	Terminated	BPS-H80-005652	COMMUNITY HEALTH CLINICS, INC.	HOMEDALE DENTAL	8 N 2nd St W	Homedale	ID
CH10016AF	Terminated	BPS-H80-002851	COMMUNITY HEALTH CLINICS, INC.	CENTENNIAL JOB CORPS	1301 RIDGECREST DR	NAMPA	ID
CH10016AG	Active	BPS-H80-008192	COMMUNITY HEALTH CLINICS, INC.	Boise Dental	2301 N 36th St	Boise	ID
CH10016AH	Terminated	BPS-H80-014907	COMMUNITY HEALTH CLINICS, INC.	Terry Reilly - Caldwell Clinic 2	1508 HOPE LN	CALDWELL	ID
CH10016AJ	Terminated	BPS-H80-030325	Community Health Clinics, Inc.	Allumbaugh House	400 N Allumbaugh St	Boise	ID
CH10016AK	Terminated	BPS-H80-030393	Community Health Clinics, Inc.	Caldwell Dental	1916 Ellis Ave	Caldwell	ID
CH10016AL	Active	BPS-H80-030690	Community Health Clinics, Inc.	Mobile Van 1	211 16th Ave N	Nampa	ID
CH10016AM	Active	BPS-H80-031542	Community Health Clinics, Inc.	Caldwell Cleveland Clinic	808 Cleveland Blvd	Caldwell	ID
CH10016AN	Active	BPS-H80-031543	Community Health Clinics, Inc.	Mobile Van 2	211 16th Ave N	Nampa	ID
CH10016AP	Active	BPS-H80-036309	COMMUNITY HEALTH CLINICS INC	Terry Reilly Florence Clinic	3115 E Florence Dr	Meridian	ID
CH10016B	Active	BPS-H80-004962	COMMUNITY HEALTH CLINICS, INC.	HOMEDALE CLINIC	108 E. IDAHO AVE	HOMEDALE	ID
CH10016D	Active	BPS-H80-001035	COMMUNITY HEALTH CLINICS, INC.	MARSING CLINIC	201 MAIN STREET	MARSING	ID
CH10016F	Active	BPS-H80-010622	COMMUNITY HEALTH CLINICS, INC.	Boise Medical/ Mental Health (Downtown)	300 S 23rd St	Boise	ID
CH10016L	Active	BPS-H80-001886	COMMUNITY HEALTH CLINICS, INC.	MELBA MEDICAL DENTAL AND BEHAVIORAL HEALTH CLINIC	150 2nd St	MELBA	ID
CH10016Y	Terminated	BPS-H80-005386	COMMUNITY HEALTH CLINICS, INC.	CALDWELL Trauma and Resilience Center	2005 ARLINGTON AVE	CALDWELL	ID
CH10016Z	Active	BPS-H80-011123	COMMUNITY HEALTH CLINICS, INC.	Terry Reilly Medical / Dental - Middleton	201 S Paradise Ave	Middleton	ID

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #166	2500 BLAINE ST	CALDWELL	ID	83605	10/01/2016
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #103	415 CLEVELAND BLVD	CALDWELL	ID	83605	10/01/2016
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #1602	715 12TH AVE S	NAMPA	ID	83651	10/01/2016
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #189	3614 WEST STATE ST	BOISE	ID	83703	10/01/2016
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #161	10700 USTICK RD	BOISE	ID	83713	04/01/2017	10/01/2021
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #177	4700 NORTH EAGLE RD	BOISE	ID	83713	04/01/2017	12/24/2017
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #160	10500 OVERLAND RD	BOISE	ID	83709	04/01/2017	12/24/2017
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #154	1520 NORTH COLE RD	BOISE	ID	83704	04/01/2017	10/01/2021
CH100160	ALBERTSONS LLC	ALBERTSONS PHARMACY #199	1219 S BROADWAY AVE	BOISE	ID	83706	04/01/2017	10/01/2021
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #164	20 EAST FAIRVIEW AVE	MERIDIAN	ID	83642-1732	04/01/2017	10/01/2021
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #3366	20 E WYOMING AVE	HOMEDALE	ID	83628	04/01/2017
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #176	2400 12TH AVENUE RD	NAMPA	ID	83686	04/01/2017
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #101	1650 W. STATE STREET	BOISE	ID	83702	04/01/2017
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #162	5100 OVERLAND RD	BOISE	ID	83705	04/01/2017
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #193	1653 S. VISTA AVE	BOISE	ID	83705	04/01/2017
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #168	405 S MAIN ST	PAYETTE	ID	83661	04/01/2017	12/24/2017
CH100160	ALBERTSONS LLC	SAV-ON PHARMACY #184	6560 SOUTH FEDERAL WAY	BOISE	ID	83716	04/01/2017	10/01/2021
CH100160	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022
CH100160	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022
CH100160	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022
CH100160	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022
CH100160	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022
CH100160	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022
CH100160	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022
CH100160	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022
CH100160	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022
CH100160	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CH100160	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2022
CH100160	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2022
CH100160	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CH100160	FRED MEYER	50 SECOND STREET SOUTH		NAMPA	ID	83651-3700	07/01/2016
CH100160	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	07/01/2016
CH100160	IDAHO CVS PHARMACY, L.L.C.	CVS PHARMACY # 17284	16300 N MARKET PLACE BLVD	NAMPA	ID	83687	04/01/2022
CH100160	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022
CH100160	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CH100160	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CH100160	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	04/01/2022
CH100160	RIDLEYS FOOD & DRUG	430 E MAIN ST		MIDDLETON	ID	83644-3036	07/01/2016
CH100160	ROE & ROE INC	HOMEDALE DRUGS	5 N MAIN ST PO BOX 37	HOMEDALE	ID	83628	07/01/2016	12/09/2023
CH100160	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH100160	WAL-MART PHARMACY 10-2508	8300 WEST OVERLAND ROAD		BOISE	ID	83709	07/01/2016
CH100160	WAL-MART PHARMACY 10-2780	5108 EAST CLEVELAND BLVD		CALDWELL	ID	83607	07/01/2016
CH100160	WAL-MART PHARMACY 10-2781	2100 12TH AVENUE ROAD		NAMPA	ID	83686	07/01/2016
CH100160	WAL-MART PHARMACY 10-2861	7319 WEST STATE STREET	PO BOX 1407	GARDEN CITY	ID	83714	05/05/2021
CH100160	WAL-MART PHARMACY 10-3739	5875 EAST FRANKLIN RD		NAMPA	ID	83687	07/01/2016
CH100160	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH100160	WALGREEN CO	DBA: WALGREENS #12123	3395 S. FEDERAL WAY	BOISE	ID	83705	10/03/2012	02/28/2024
CH100160	WALGREEN CO	DBA: WALGREENS #10672	2219 12TH AVE RD	NAMPA	ID	83686-6313	01/01/2014
CH100160	WALGREEN CO	DBA: WALGREENS #11541	4110 S. 10TH AVENUE	CALDWELL	ID	83605	01/01/2014
CH100160	WALGREEN CO	DBA: WALGREENS #10604	1625 S MERIDIAN RD	MERIDIAN	ID	83642-6002	05/05/2021
CH100160	WALGREEN CO.	DBA: WALGREENS # 05184	10580 W USTICK RD	BOISE	ID	83704	10/03/2012
CH100160	WALGREEN CO.	DBA: WALGREENS # 04942	8100 W FAIRVIEW AVE.	BOISE	ID	83704	10/03/2012
CH100160	WALGREEN CO.	DBA: WALGREENS # 05185	4924 OVERLAND RD	BOISE	ID	83705	10/03/2012
CH100160	WALGREEN CO.	DBA: WALGREENS # 05565	10555 W OVERLAND RD	BOISE	ID	83709	10/03/2012
CH100160	WALGREEN CO.	DBA: WALGREENS # 01972	6725 N GLENWOOD ST	BOISE	ID	83714	04/01/2013
CH100160	WALGREEN CO.	DBA: WALGREENS #13888	455 S. BROADWAY AVE.	BOISE	ID	83702	04/01/2013
CH100160	WALGREEN CO.	DBA: WALGREENS # 05648	700 12TH AVENUE S	NAMPA	ID	83651	01/01/2014
CH100160	WALGREEN CO.	DBA: WALGREENS # 07276	1012 CLEVELAND BLVD	CALDWELL	ID	83605-3852	01/01/2014
CH100160	WALGREEN CO.	DBA: WALGREENS # 10197	3150 W CHERRY LANE	MERIDIAN	ID	83642-1122	01/01/2014
CH100160	WALGREEN CO.	DBA: WALGREENS #11083	6195 S FIVE MILE	BOISE	ID	83709	01/01/2014
CH100160	WALGREEN CO.	DBA: WALGREENS #12124	265 S EAGLE RD	EAGLE	ID	83616	01/01/2014
CH100160	WALGREEN CO.	DBA: WALGREENS #12483	932 CALDWELL BLVD	NAMPA	ID	83651	01/01/2014
CH100160	WALGREEN CO.	DBA; WALGREENS #13614	869 E AVALON ST	KUNA	ID	83634	10/01/2019
CH100160	WALGREEN CO.	DBA: WALGREENS # 06200	1570 E FAIRVIEW AVE	MERIDIAN	ID	83642	10/01/2021
CH100160	WALGREEN CO.	DBA: WALGREENS #11687	4850 N LINDER RD	MERIDIAN	ID	83646	04/01/2022
CH100160	Walgreens #21435	Walgreens Central Fill #21435	6306 S Airport Rd	West Jordan	UT	84084-5601	01/01/2024
CH100160	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/01/2014
CH100160	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/01/2015	06/21/2017
CH100160	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2018
CH100160	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2018
CH100160	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH100160	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	4/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		12/11/2020 12:00:00 AM	2/9/2021 11:42 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/9/2021 11:42 AM
Terminations	Termination Date	Update	Recertification		4/1/2021 12:00:00 AM	2/9/2021 11:42 AM
Terminations	Termination Effective Date	Update	Recertification		12/11/2020 12:00:00 AM	2/9/2021 11:42 AM
Terminations	Termination Reason	Update	Recertification		Site closure	2/9/2021 11:42 AM
Contacts	Primary Contact	Update	Change Request	Henggeler, Hollister Director of Pharmacy Community Health Clinics Inc 2083181315	Henggeler, Hollister A Pharmacy Director Community Health Clinics, Inc 2083181315	8/4/2020 7:48 AM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Primary Contact	Update	Change Request	Baldwin, Brian CFO Terry Reilly Health Services 2083181242	Henggeler, Hollister Director of Pharmacy Community Health Clinics Inc 2083181315	6/19/2020 2:07 PM
Contacts	Signed By	Insert	New Registration		Hart, Heidi CEO Terry Reilly Health Services 2083181255	4/21/2020 10:00 AM
Details	340B ID	Update	New Registration		CH10016AK	4/21/2020 10:00 AM
Dates	Participating Approval Date	Update	New Registration		4/21/2020 10:00:48 AM	4/21/2020 10:00 AM
Details	State	Update	New Registration	Pending	Approved	4/21/2020 10:00 AM
Dates	Signed By Date	Update	New Registration		4/14/2020 5:20:15 PM	4/21/2020 10:00 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/21/2020 10:00 AM
Addresses	Main Address	Insert	New Registration		1916 Ellis Ave Caldwell, ID 83605-4811	4/14/2020 3:14 PM
Addresses	Billing Address	Insert	New Registration		Community Health Clinics Inc 211 16th Avenue North PO Box 9 Nampa, ID 83653	4/14/2020 3:14 PM
Addresses	Shipping Address	Insert	New Registration		Community Health Clinics, Inc 207 1st Street South Nampa, ID 83651	4/14/2020 3:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1477560654	4/14/2020 3:14 PM
Contacts	Authorizing Official	Insert	New Registration		Hart, Heidi CEO Terry Reilly Health Services 2083181255	4/14/2020 3:14 PM
Contacts	Primary Contact	Insert	New Registration		Baldwin, Brian CFO Terry Reilly Health Services 2083181242	4/14/2020 3:14 PM
Details	Last Recertification Date	Insert	New Registration			4/14/2020 3:14 PM
Details	Grant Number	Insert	New Registration		H80CS00636	4/14/2020 3:14 PM
Details	340B ID	Insert	New Registration			4/14/2020 3:14 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2020 3:14 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2020 3:14 PM
Details	Medicare Provider Number	Insert	New Registration			4/14/2020 3:14 PM
Details	Entity Name	Insert	New Registration		Community Health Clinics, Inc.	4/14/2020 3:14 PM
Details	Program Code	Insert	New Registration		CH	4/14/2020 3:14 PM
Details	Entity Subname	Insert	New Registration		Caldwell Dental	4/14/2020 3:14 PM
Dates	Participating Approval Date	Insert	New Registration			4/14/2020 3:14 PM
Details	State	Insert	New Registration		Pending	4/14/2020 3:14 PM
Dates	Registration Date	Insert	New Registration		4/14/2020 3:14:20 PM	4/14/2020 3:14 PM
Dates	Signed By Date	Insert	New Registration			4/14/2020 3:14 PM
Dates	Start Date	Insert	New Registration			4/14/2020 3:14 PM
Terminations	Termination Comments	Insert	New Registration			4/14/2020 3:14 PM
Terminations	Termination Date	Insert	New Registration			4/14/2020 3:14 PM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2020 3:14 PM
Terminations	Termination Reason	Insert	New Registration			4/14/2020 3:14 PM

340B Drug Pricing Program Database