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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CH081260E Mountain Family Health Centers
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Covered Entity Details
Entity Name
Mountain Family Health Centers
Subdivision Name
Mountain Family Health Centers Rifle
Type
HRSA-Funded Health Center
340B ID
CH081260E
Entity Address
195 W. 14th St., Bldg C
Rifle, CO 81650-4717
Grant Number
H80CS00830
Participating Start Date
10/1/2011
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
3/6/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/5/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Art M Fernandez, Chief Operating Officer
(970) 945-2840 Ext: 7205
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
3/6/2018
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