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CYSTIC FIBROSIS SERVICES, LLC
DSH050394 CMH OF SAN BUENAVENTURA
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Covered Entity Details
Entity Name
CMH OF SAN BUENAVENTURA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050394
Entity Address
147 N. BRENT STREET
VENTURA, CA 93003
Medicare Provider Number
050394
Participating Start Date
10/1/2019
Last Recertification Date
8/22/2024
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
1/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James A Corwin, Chief Financial Officer
(805) 948-5003
Contract Pharmacy Representative
WALGREENS CO
KARL MEEHAN, VICE PRESIDENT,HEALTH SYSTEMS PROGRAMS
(847) 315-2663
Signed By Date
1/12/2021
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