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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CHC28348-00 APPALACHIAN MOUNTAIN COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
APPALACHIAN MOUNTAIN COMMUNITY HEALTH CENTERS
Subdivision Name
Dale Fell Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC28348-00
Entity Address
77 McDowell Street
Asheville, NC 28801-4435
Grant Number
H80CS28348
Participating Start Date
10/1/2016
Last Recertification Date
2/12/2025
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
4/5/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/13/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Shantelle Simpson, CEO
(828) 202-5200 Ext: 3865
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/5/2022
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