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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
DSH230035 Corewell Health Greenville Hospital
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Covered Entity Details
Entity Name
Corewell Health Greenville Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230035
Entity Address
615 S. BOWER STREET
GREENVILLE, MI 48838
Medicare Provider Number
230035
Participating Start Date
1/20/2010
Last Recertification Date
8/22/2024
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
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/29/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Tom Knoerl, Controller
(231) 592-4253
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2021
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