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CYSTIC FIBROSIS SERVICES, LLC
DSH300012 ELLIOT HOSPITAL
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Covered Entity Details
Entity Name
ELLIOT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH300012
Entity Address
1 ELLIOT WAY
MANCHESTER, NH 03103
Medicare Provider Number
300012
Participating Start Date
3/12/2021
Last Recertification Date
9/14/2022
Entity Termination Date
1/1/2023
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
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Turilli, Vice President - Finance
(978) 430-1352
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2018
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