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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CH091540 OPEN DOOR COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
OPEN DOOR COMMUNITY HEALTH CENTERS
Subdivision Name
Arcata Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH091540
Entity Address
1150 Foster Avenue
Arcata, CA 95521-6210
Grant Number
H80CS00225
Participating Start Date
7/1/1996
Last Recertification Date
2/24/2025
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
2/24/2022
Contract Begin Date
2/28/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/3/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Joseph Henry Demont, Chief Financial Officer
(707) 826-8633 Ext: 5106
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/24/2022
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