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CYSTIC FIBROSIS SERVICES, LLC
SCH270003-00 ST. PETERS HEALTH
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Covered Entity Details
Entity Name
ST. PETERS HEALTH
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH270003-00
Entity Address
2475 E Broadway St.
HELENA, MT 59601
Medicare Provider Number
270003
Participating Start Date
3/15/2022
Last Recertification Date
8/23/2024
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
7/12/2019
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nathan M Coburn, CFO
(406) 444-2122
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2019
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