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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
DSH450330 OAKBEND MEDICAL CENTER
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Covered Entity Details
Entity Name
OAKBEND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450330
Entity Address
1705 JACKSON ST
RICHMOND, TX 77469
Medicare Provider Number
450330
Participating Start Date
1/1/2024
Last Recertification Date
8/29/2024
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
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jeffrey Hammel, CFO
(281) 341-4881
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2017
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