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CYSTIC FIBROSIS SERVICES, LLC
STD875052 La Familia Medical Center
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Covered Entity Details
Entity Name
La Familia Medical Center
Subdivision Name
Healthcare for the Homeless
Type
Sexually Transmitted Diseases
340B ID
STD875052
Entity Address
1532 B Cerrillos Rd
Santa Fe, NM 87505
Grant Number
1 NH25PS005180-01-00
Participating Start Date
4/1/2014
Last Recertification Date
5/14/2021
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
1/17/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/24/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jay Jolly, CEO
(505) 955-0310
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2021
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