Contract Pharmacy Details

PRIME THERAPEUTICS SPECIALTY PHARMACY LL
DSH160082 IOWA METHODIST MEDICAL CENTER

Covered Entity Details

Entity Name

IOWA METHODIST MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH160082

Entity Address

1200 PLEASANT STREET
DES MOINES, IA 50309

Medicare Provider Number

160082

Participating Start Date

7/1/2017

Last Recertification Date

8/23/2024

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

7/12/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/31/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Eric Lothe, SVP/COO
(515) 241-5858

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/12/2017

340B Drug Pricing Program Database