Contract Pharmacy Details

CYSTIC FIBROSIS SERVICES, LLC
DSH320089 UNM SANDOVAL REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

UNM SANDOVAL REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH320089

Entity Address

3001 BROADMOOR BLVD NE
RIO RANCHO, NM 87144

Medicare Provider Number

320089

Participating Start Date

4/1/2016

Last Recertification Date

8/17/2023

Entity Termination Date

4/1/2024

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

1/17/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jamie Silva-Steele, President and CEO
(505) 994-7430

Contract Pharmacy Representative

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

Signed By Date

1/17/2020

340B Drug Pricing Program Database