Contract Pharmacy Details

PRIME THERAPEUTICS SPECIALTY PHARMACY LL
RWII32501A AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER PENSACOLA /MOBILE TREATMENT/TESTING VAN

Type

Ryan White Part B

340B ID

RWII32501A

Entity Address

4300 BAYOU BLVD
SUITE 17D
Pensacola, FL 32503

Grant Number

X07HA00057

Participating Start Date

7/1/2010

Last Recertification Date

2/16/2023

Entity Termination Date

1/1/2024

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

4/13/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/13/2021

340B Drug Pricing Program Database