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CYSTIC FIBROSIS SERVICES, LLC
PED053305-00 LUCILE PACKARD CHILDREN'S HOSPITAL
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Covered Entity Details
Entity Name
LUCILE PACKARD CHILDREN'S HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED053305-00
Entity Address
725 WELCH ROAD
PALO ALTO, CA 94304
Medicare Provider Number
053305
Participating Start Date
1/19/2010
Last Recertification Date
9/4/2024
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
7/27/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dana Haering, Chief Financial Officer
(650) 721-2222
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/27/2018
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