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CYSTIC FIBROSIS SERVICES, LLC
CH020710 NEWARK DEPARTMENT OF HEALTH AND HUMAN SERVICES
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Covered Entity Details
Entity Name
NEWARK DEPARTMENT OF HEALTH AND HUMAN SERVICES
Subdivision Name
Mary Eliza Mahoney Health Center @110 William Street
Type
HRSA-Funded Health Center
340B ID
CH020710
Entity Address
110 WILLIAM STREET
ROOM 208
NEWARK, NJ 07102
Grant Number
H80CS00009
Participating Start Date
4/1/2018
Last Recertification Date
2/11/2025
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
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Mark J Wade, CEO
(973) 733-5310
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2018
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