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CYSTIC FIBROSIS SERVICES, LLC
CAH221303-00 Athol Memorial Hospital
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Covered Entity Details
Entity Name
Athol Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH221303-00
Entity Address
2033 Main St.
Athol, MA 01331
Medicare Provider Number
221303
Participating Start Date
4/1/2013
Last Recertification Date
9/4/2024
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
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Abbatiello, CFO
(978) 630-6157
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2021
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