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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
DSH100007 AdventHealth Orlando
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Covered Entity Details
Entity Name
AdventHealth Orlando
Subdivision Name
Florida Hospital Orlando
Type
Disproportionate Share Hospital
340B ID
DSH100007
Entity Address
601 E. Rollins St.
Orlando, FL 32803-1248
Medicare Provider Number
100007
Participating Start Date
4/1/2012
Last Recertification Date
8/29/2024
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
7/5/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Daniel Myers, Senior Vice President Finance
(407) 303-5501
Contract Pharmacy Representative
Walgreens
Karl Meehan, VP Health System Programs
(847) 315-2663
Signed By Date
7/5/2019
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