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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CH044700 Bayou La Batre Area Health Development Board, Inc
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Covered Entity Details
Entity Name
Bayou La Batre Area Health Development Board, Inc
Subdivision Name
MOSTELLAR MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH044700
Entity Address
12701 PADGETT SWITCH ROAD
IRVINGTON, AL 36544-4011
Grant Number
H80CS00098
Participating Start Date
7/1/2001
Last Recertification Date
2/20/2025
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
1/4/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES A. HOLLAND, CEO
(251) 824-2174 Ext: 5229
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/4/2018
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