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CYSTIC FIBROSIS SERVICES, LLC
DSH310009 CLARA MAASS MEDICAL CENTER
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Covered Entity Details
Entity Name
CLARA MAASS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310009
Entity Address
ONE CLARA MAASS DRIVE
BELLEVILLE, NJ 07109-3550
Medicare Provider Number
310009
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
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
7/19/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
YASMIR BISAL, Vice President Finance
(973) 450-2164
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/19/2022
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