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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
PED243302-00 Children’s Health Care d/b/a Children’s Minnesota
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Covered Entity Details
Entity Name
Children’s Health Care d/b/a Children’s Minnesota
Subdivision Name
MINNEAPOLIS CAMPUS
Type
Children's Hospital
340B ID
PED243302-00
Entity Address
2525 CHICAGO AVENUE SOUTH
MINNEAPOLIS, MN 55404
Medicare Provider Number
243302
Participating Start Date
1/1/2015
Last Recertification Date
8/27/2024
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
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
MARIA CHRISTU, CHIEF LEGAL OFFICER
(612) 813-6110
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2017
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