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CYSTIC FIBROSIS SERVICES, LLC
STD833012 UNM Truman Health Services
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Covered Entity Details
Entity Name
UNM Truman Health Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD833012
Entity Address
801 Encino Place NE Building-F
Albuquerque, NM 87102
Grant Number
1 NH25PS005180-01-00
Participating Start Date
10/1/2019
Last Recertification Date
5/6/2024
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
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/14/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marjorie Goldstein, CFO
(505) 272-3558
Contract Pharmacy Representative
Truman
Sam Sanchez, Director, Pharmacy Services
(505) 925-0988
Signed By Date
7/14/2021
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