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CYSTIC FIBROSIS SERVICES, LLC
SCH060076-00 STERLING REGIONAL MEDCENTER
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Covered Entity Details
Entity Name
STERLING REGIONAL MEDCENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH060076-00
Entity Address
615 FAIRHURST STREET
STERLING, CO 80751
Medicare Provider Number
060076
Participating Start Date
10/1/2018
Last Recertification Date
8/29/2023
Entity Termination Date
1/1/2024
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
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DENA KLOCKMAN, CHIEF FINANCIAL OFFICER
(308) 284-7263
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2019
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