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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
DSH330395 EPISCOPAL HEALTH SERVICES INC
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Covered Entity Details
Entity Name
EPISCOPAL HEALTH SERVICES INC
Subdivision Name
ST JOHN'S EPISCOPAL HOSPITAL - SOUTH SHORE
Type
Disproportionate Share Hospital
340B ID
DSH330395
Entity Address
327 BEACH 19TH STREET
FAR ROCKAWAY, NY 11691
Medicare Provider Number
330395
Participating Start Date
12/15/2005
Last Recertification Date
9/17/2024
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
4/17/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gerard M. Walsh, CEO
(718) 869-7320
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/17/2018
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