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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
DSH330014A JAMAICA HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
JAMAICA HOSPITAL MEDICAL CENTER
Subdivision Name
THE JAMAICA HOSPITAL WOMEN'S HEALTH CENTER
Type
Disproportionate Share Hospital
340B ID
DSH330014A
Entity Address
133-03 JAMAICA AVENUE
RICHMOND HILLS, NY 11418
Medicare Provider Number
330014
Outpatient Facility Provider Number
Participating Start Date
1/1/2007
Last Recertification Date
8/14/2024
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
7/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MOUNIR F. DOSS, EXECUTIVE VP & CFO
(718) 206-6291
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/7/2017
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