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CYSTIC FIBROSIS SERVICES, LLC
DSH030036 CHANDLER REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CHANDLER REGIONAL MEDICAL CENTER
Subdivision Name
CHANDLER REGIONAL MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH030036
Entity Address
1955 W. Frye Road
CHANDLER, AZ 85224
Medicare Provider Number
030036
Participating Start Date
1/1/2015
Last Recertification Date
9/4/2020
Entity Termination Date
10/5/2021
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
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Eric Sorensen, CFO
(480) 728-3144 Ext: 4807283144
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2019
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