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CYSTIC FIBROSIS SERVICES, LLC
CHC26511-11 Upper Great Lakes Family Health Center
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Covered Entity Details
Entity Name
Upper Great Lakes Family Health Center
Subdivision Name
Marquette Family Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26511-11
Entity Address
1414 W Fair Ave
Ste 249
Marquette, MI 49855
Grant Number
H80CS26511
Participating Start Date
6/10/2020
Last Recertification Date
2/12/2025
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
1/4/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald A. Simila, CEO
(906) 481-8571
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/4/2021
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