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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CAH051309-00 JEROLD PHELPS COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
JEROLD PHELPS COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051309-00
Entity Address
733 CEDAR STREET
GARBERVILLE, CA 95542
Medicare Provider Number
051309
Participating Start Date
10/1/2016
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
10/11/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/14/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paul M. Eves, Chief Financial Officer
(707) 923-3921 Ext: 291
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2017
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