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CYSTIC FIBROSIS SERVICES, LLC
DSH500129 TACOMA GENERAL/ALLENMORE HOSPITAL
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Covered Entity Details
Entity Name
TACOMA GENERAL/ALLENMORE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500129
Entity Address
315 MARTIN LUTHER KING JR WAY
TACOMA, WA 98405-4234
Medicare Provider Number
500129
Participating Start Date
12/1/2005
Last Recertification Date
8/18/2024
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
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/7/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
Walgreens
Erin Kayser, Health Systems Solutions Director
(949) 280-7219
Signed By Date
4/12/2019
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