Contract Pharmacy Details

PRIME THERAPEUTICS SPECIALTY PHARMACY LL
DSH500088 PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER

Covered Entity Details

Entity Name

PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500088

Entity Address

400 S 43RD STREET
RENTON, WA 98055-5010

Medicare Provider Number

500088

Participating Start Date

10/4/2005

Last Recertification Date

8/20/2024

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

10/24/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Jeannine Grinnell, Chief Executive and Financial Officer
(425) 690-3310

Contract Pharmacy Representative

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

Signed By Date

10/16/2017

340B Drug Pricing Program Database