Contract Pharmacy Details

CYSTIC FIBROSIS SERVICES, LLC
DSH310019 St. Joseph’s University Medical Center

Covered Entity Details

Entity Name

St. Joseph’s University Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH310019

Entity Address

703 MAIN STREET
PATERSON, NJ 07503

Medicare Provider Number

310019

Participating Start Date

10/1/2002

Last Recertification Date

8/27/2024

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

10/8/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kevin Slavin, President and CEO
(973) 754-2010

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/8/2021

340B Drug Pricing Program Database