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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CAH231333-00 ASPIRUS IRONWOOD HOSPITAL
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Covered Entity Details
Entity Name
ASPIRUS IRONWOOD HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH231333-00
Entity Address
N10561 GRAND VIEW LANE
IRONWOOD, MI 49938
Medicare Provider Number
231333
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
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
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/6/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Paula Chermside, CEO
(906) 932-2525
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2020
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