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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CAH521351-00 REEDSBURG AREA MEDICAL CENTER
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Covered Entity Details
Entity Name
REEDSBURG AREA MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521351-00
Entity Address
2000 N DEWEY AVE
REEDSBURG, WI 53959
Medicare Provider Number
521351
Participating Start Date
1/1/2011
Last Recertification Date
8/30/2024
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
6/29/2020
Contract Begin Date
6/29/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
ROBERT VANMEETEREN, CEO/PRESIDENT
(608) 524-6487
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/29/2020
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