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CYSTIC FIBROSIS SERVICES, LLC
RWI07960B New Jersey AIDS Services
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Covered Entity Details
Entity Name
New Jersey AIDS Services
Subdivision Name
EDGE Wellness Center
Type
Ryan White Part A
340B ID
RWI07960B
Entity Address
3155 St. Route 10
Suite 204
Denville, NJ 07834
Grant Number
H89HA00003
Participating Start Date
4/1/2020
Last Recertification Date
2/11/2022
Entity Termination Date
7/1/2022
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
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
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
10/15/2020
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