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CYSTIC FIBROSIS SERVICES, LLC
CAH501319-00 LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH
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Covered Entity Details
Entity Name
LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501319-00
Entity Address
521 Adams Avenue
MORTON, WA 98356
Medicare Provider Number
501319
Participating Start Date
7/1/2011
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
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Boggess, CHIEF FINANCIAL OFFICER
(360) 496-3647
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/11/2019
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