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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
DSH340053 Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
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Covered Entity Details
Entity Name
Presbyterian Hospital, d/b/a Novant Health Presbyterian Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340053
Entity Address
200 HAWTHORNE LANE
CHARLOTTE, NC 28204
Medicare Provider Number
340053
Participating Start Date
4/1/2008
Last Recertification Date
8/23/2024
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
10/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Geoffrey Gardner, SVP Finance
(336) 718-2078
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2020
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