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CYSTIC FIBROSIS SERVICES, LLC
CH034100 PORTSMOUTH COMMUNITY HEALTH CENTER, INC.,d/b/a Hampton Roads Community Health Center
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Covered Entity Details
Entity Name
PORTSMOUTH COMMUNITY HEALTH CENTER, INC.,d/b/a Hampton Roads Community Health Center
Subdivision Name
PORTSMOUTH COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH034100
Entity Address
664 Lincoln St
Portsmouth, VA 23704-4818
Grant Number
H80CS00729
Participating Start Date
1/1/1994
Last Recertification Date
1/31/2023
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
10/9/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Barbara Willis, CEO
(757) 393-6363
Contract Pharmacy Representative
Walgreens
Aliena Jaffri, 340b Client Relationship Analyst
(847) 964-6103
Signed By Date
10/9/2019
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