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CYSTIC FIBROSIS SERVICES, LLC
CHC00341-00 PRIMECARE COMMUNITY HEALTH INC
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Covered Entity Details
Entity Name
PRIMECARE COMMUNITY HEALTH INC
Subdivision Name
PRIMECARE WEST TOWN
Type
HRSA-Funded Health Center
340B ID
CHC00341-00
Entity Address
1431 N Western Ave
Ste 406
Chicago, IL 60622
Grant Number
H80CS00341
Participating Start Date
4/1/2013
Last Recertification Date
2/10/2025
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
1/14/2021
Contract Begin Date
1/21/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Van Gilder, CFO
(314) 800-6161
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2021
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