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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
DSH050254 MARSHALL HOSPITAL
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Covered Entity Details
Entity Name
MARSHALL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050254
Entity Address
1100 MARSHALL WAY
PLACERVILLE, CA 95667
Medicare Provider Number
050254
Participating Start Date
1/1/2016
Last Recertification Date
8/12/2024
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
7/10/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/7/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
James Whipple, Chief Executive Officer
(530) 626-2601
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/10/2017
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