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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CAH131307-01 Weiser Valley Hospital District, dba Weiser Memorial Hospital
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Covered Entity Details
Entity Name
Weiser Valley Hospital District, dba Weiser Memorial Hospital
Subdivision Name
Weiser Memorial Hospital Clinic (WMH Clinic)
Type
Critical Access Hospital
340B ID
CAH131307-01
Entity Address
360 East Liberty Street
Weiser, ID 83672
Medicare Provider Number
131307
Outpatient Facility Provider Number
Participating Start Date
7/1/2013
Last Recertification Date
8/21/2024
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
10/16/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Hale, CEO
(208) 549-4450
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2018
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