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CYSTIC FIBROSIS SERVICES, LLC
FP191071 MAZZONI CENTER
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Covered Entity Details
Entity Name
MAZZONI CENTER
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP191071
Entity Address
1348 BAINBRIDGE STREET
PHILADELPHIA, PA 19147
Grant Number
FPHPA006433
Participating Start Date
4/1/2003
Last Recertification Date
5/17/2023
Entity Termination Date
7/1/2024
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
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/22/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Anthony Rodriguez, President
(215) 563-0652
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2017
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