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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CH081460 PEAK VISTA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
PEAK VISTA COMMUNITY HEALTH CENTERS
Subdivision Name
Peak Vista Administrative Services Center
Type
HRSA-Funded Health Center
340B ID
CH081460
Entity Address
3205 N Academy Blvd Ste 130
Colorado Springs, CO 80917
Grant Number
H80CS00212
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
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
4/6/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/8/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Lisa Ramey, CMDO
(719) 344-6455
Contract Pharmacy Representative
Peak Vista Community Health Centers
Katie Boudreaux, Vice President of Pharmacy Services
(719) 344-6269
Signed By Date
4/6/2022
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