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CYSTIC FIBROSIS SERVICES, LLC
DSH220071 MASSACHUSETTS GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MASSACHUSETTS GENERAL HOSPITAL
Subdivision Name
The General Hospital Corporation
Type
Disproportionate Share Hospital
340B ID
DSH220071
Entity Address
55 FRUIT STREET
BOSTON, MA 02114
Medicare Provider Number
220071
Participating Start Date
3/24/2021
Last Recertification Date
9/5/2024
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
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/30/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sally Mason Boemer, Senior Vice President of Finance
(617) 724-4537
Contract Pharmacy Representative
Massachusetts General Hospital
Rafic Nehme, Director, Pharmacy Business & Finance
(617) 726-5125
Signed By Date
1/15/2019
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