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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
RRC360070-00 CLEVELAND CLINIC MERCY HOSPITAL
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Covered Entity Details
Entity Name
CLEVELAND CLINIC MERCY HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360070-00
Entity Address
1320 MERCY DRIVE N.W
CANTON, OH 44708
Medicare Provider Number
360070
Participating Start Date
7/1/2020
Last Recertification Date
8/15/2024
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
1/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
David K Stewart, SVP / COO / CFO
(330) 489-1007
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2021
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