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CYSTIC FIBROSIS SERVICES, LLC
CAH201308-00 HOULTON REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
HOULTON REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201308-00
Entity Address
20 HARTFORD STREET
HOULTON, ME 04730
Medicare Provider Number
201308
Participating Start Date
9/15/2010
Last Recertification Date
8/16/2024
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
7/11/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CYNTHIA THOMPSON, CFO
(207) 532-2900 Ext: 2142
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/11/2018
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