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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
PED063301-00 Children's Hospital Colorado
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Covered Entity Details
Entity Name
Children's Hospital Colorado
Subdivision Name
Type
Children's Hospital
340B ID
PED063301-00
Entity Address
13123 EAST 16TH AVENUE
AURORA, CO 80045
Medicare Provider Number
063301
Participating Start Date
9/9/2010
Last Recertification Date
9/4/2024
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
4/18/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/13/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Jerrod Milton, Senior Vice President Professional & Support Services
(720) 777-2839
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/18/2018
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