340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PRIME THERAPEUTICS SPECIALTY PHARMACY LL
RRC230146-00 HENRY FORD HEALTH WYANDOTTE HOSPITAL
Print
Covered Entity Details
Entity Name
HENRY FORD HEALTH WYANDOTTE HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC230146-00
Entity Address
2333 BIDDLE
WYANDOTTE, MI 48192
Medicare Provider Number
230146
Participating Start Date
7/1/2018
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
PRIME THERAPEUTICS SPECIALTY PHARMACY LL
Pharmacy Address
ALLIANCERX WALGREENS PRIME #16568
2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDO, FL 32819-9992
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Robin Damschroder, CFO
(313) 876-8421
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/16/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session