Contract Pharmacy Details

CYSTIC FIBROSIS SERVICES, LLC
DSH050006 St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital

Covered Entity Details

Entity Name

St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050006

Entity Address

2700 DOLBEER STREET
EUREKA, CA 95501

Medicare Provider Number

050006

Participating Start Date

4/1/2009

Last Recertification Date

8/16/2024

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

7/26/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/2/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Kevin Klockenga, CEO
(707) 522-1520

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/26/2019

340B Drug Pricing Program Database