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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CH041294K NORTH BROWARD HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
NORTH BROWARD HOSPITAL DISTRICT
Subdivision Name
Bernard P. Alicki Health Center
Type
HRSA-Funded Health Center
340B ID
CH041294K
Entity Address
1101 W Broward Blvd
Fort Lauderdale, FL 33312-1638
Grant Number
H80CS00019
Participating Start Date
4/1/2015
Last Recertification Date
2/28/2025
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
4/20/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/26/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Beth A Cherry, Vice President
(954) 473-3076
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/20/2018
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