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CYSTIC FIBROSIS SERVICES, LLC
PED073300-00 CONNECTICUT CHILDREN'S MEDICAL CENTER
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Covered Entity Details
Entity Name
CONNECTICUT CHILDREN'S MEDICAL CENTER
Subdivision Name
Type
Children's Hospital
340B ID
PED073300-00
Entity Address
282 WASHINGTON STREET
HARTFORD, CT 06106
Medicare Provider Number
073300
Participating Start Date
7/1/2010
Last Recertification Date
8/26/2024
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
4/9/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gil Peri, President & COO
(860) 885-8587
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/9/2019
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