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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CHC24103-00 Esperanza Health Centers
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Covered Entity Details
Entity Name
Esperanza Health Centers
Subdivision Name
Esperanza California
Type
HRSA-Funded Health Center
340B ID
CHC24103-00
Entity Address
2001 S California Ave STE 100
Chicago, IL 60608-2486
Grant Number
H80CS24103
Participating Start Date
4/1/2013
Last Recertification Date
2/12/2025
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
10/3/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/6/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Dan Fulwiler, CEO
(773) 584-6200
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/3/2019
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