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CYSTIC FIBROSIS SERVICES, LLC
RRC390045-00 WILLIAMSPORT HOSPITAL & MEDICAL CTR
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Covered Entity Details
Entity Name
WILLIAMSPORT HOSPITAL & MEDICAL CTR
Subdivision Name
Type
Rural Referral Center
340B ID
RRC390045-00
Entity Address
700 HIGH STREET
WILLIAMSPORT, PA 17701
Medicare Provider Number
390045
Participating Start Date
10/1/2024
Last Recertification Date
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
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Christopher Stockhausen, CFO
(412) 664-2528
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2022
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