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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CHC26595-00 PENNYROYAL HEALTHCARE SERVICES INC.
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Covered Entity Details
Entity Name
PENNYROYAL HEALTHCARE SERVICES INC.
Subdivision Name
Community Medical Clinic, Princeton
Type
HRSA-Funded Health Center
340B ID
CHC26595-00
Entity Address
1022 W, Main St.
PRINCETON, KY 42445-1622
Grant Number
H80CS26595
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2025
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
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Kecia Fulcher, CEO
(270) 365-0227
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2018
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