340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PRIME THERAPEUTICS SPECIALTY PHARMACY LL
DSH100034 MOUNT SINAI MEDICAL CENTER
Print
Covered Entity Details
Entity Name
MOUNT SINAI MEDICAL CENTER
Subdivision Name
MOUNT SINAI MEDICAL CENTER OF FLORIDA INC.
Type
Disproportionate Share Hospital
340B ID
DSH100034
Entity Address
4300 Alton Road
MIAMI BEACH, FL 33140
Medicare Provider Number
100034
Participating Start Date
4/1/2007
Last Recertification Date
9/3/2024
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
7/10/2019
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
ANGEL PALLIN, SVP OF OPERATIONS
(305) 674-2520
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/10/2019
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