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CH07055Y PRIMARY HEALTH CARE INC (Terminated)
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Main Details
Name
PRIMARY HEALTH CARE INC
Subdivision Name
Primary Health Care at Youth Emergency Shelter Services
Type
HRSA-Funded Health Center
Site ID
BPS-H80-007389
340B ID
CH07055Y
Grant Number
H80CS00715
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2012
Participating Start Date
1/1/2013
Participating Approval Date
10/18/2012
Last Recertification Date
2/9/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
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
918 SE 11th St
Des Moines, IA 50309-5324
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
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10/18/12 - Reviewed registration and forwarded to IS for approval.
10/18/2012
April 2025
April 2025
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