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CYSTIC FIBROSIS SERVICES, LLC
STD07950 New Jersey AIDS Services
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Covered Entity Details
Entity Name
New Jersey AIDS Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD07950
Entity Address
3155 St. Route 10
Suite 204
Denville, NJ 07834
Grant Number
NU62PS924524-04-01
Participating Start Date
1/1/2020
Last Recertification Date
6/1/2022
Entity Termination Date
10/1/2022
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
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Laurie Litt, Chief Executive Officer
(973) 285-0006 Ext: 15
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2020
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