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CYSTIC FIBROSIS SERVICES, LLC
STD87502 NEW MEXICO DEPT OF HEALTH
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Covered Entity Details
Entity Name
NEW MEXICO DEPT OF HEALTH
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD87502
Entity Address
1190 S. ST. FRANCIS DRIVE
SANTA FE, NM 87505
Grant Number
NH25PS005180
Participating Start Date
1/1/2001
Last Recertification Date
5/9/2024
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
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ronald Ulibarri, Pharmacy Program Manager
(505) 476-8350
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2020
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