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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CHC26605-00 NORTHERN NEVADA HIV OUTPATIENT PROGRAM, EDUCATION AND SERVICES
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Covered Entity Details
Entity Name
NORTHERN NEVADA HIV OUTPATIENT PROGRAM, EDUCATION AND SERVICES
Subdivision Name
.
Type
HRSA-Funded Health Center
340B ID
CHC26605-00
Entity Address
580 W 5th St
Reno, NV 89503-4432
Grant Number
H80CS26605
Participating Start Date
4/1/2014
Last Recertification Date
2/20/2025
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
7/11/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sharon Chamberlain, Chief Executive Officer
(775) 348-2895
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/11/2017
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