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CYSTIC FIBROSIS SERVICES, LLC
DSH310074 JERSEY CITY MEDICAL CENTER
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Covered Entity Details
Entity Name
JERSEY CITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310074
Entity Address
355 GRAND STREET
JERSEY CITY, NJ 07302
Medicare Provider Number
310074
Participating Start Date
4/1/1997
Last Recertification Date
8/26/2024
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
7/18/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carla Hollis, COO
(201) 915-2944
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/18/2022
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