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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CH090080 MARANA HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
MARANA HEALTH CENTER, INC.
Subdivision Name
Marana Health Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH090080
Entity Address
13395 N. Marana Main Street
MARANA, AZ 85653
Grant Number
H80CS00231
Participating Start Date
7/1/1999
Last Recertification Date
2/10/2025
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
7/3/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Tamie Olson, Chief Financial Officer
(520) 682-4111 Ext: 6221
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/3/2019
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