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CYSTIC FIBROSIS SERVICES, LLC
CAH301310-00 ANDROSCOGGIN VALLEY HOSPITAL , Inc.
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Covered Entity Details
Entity Name
ANDROSCOGGIN VALLEY HOSPITAL , Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301310-00
Entity Address
59 PAGE HILL ROAD
BERLIN, NH 03570-3542
Medicare Provider Number
301310
Participating Start Date
9/29/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
4/23/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/21/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lucien B StOnge, VP of FInance
(603) 326-5610
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/23/2018
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