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CYSTIC FIBROSIS SERVICES, LLC
DSH070010 BRIDGEPORT HOSPITAL
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Covered Entity Details
Entity Name
BRIDGEPORT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070010
Entity Address
267 GRANT STREET
BRIDGEPORT, CT 06610-0120
Medicare Provider Number
070010
Participating Start Date
4/1/2006
Last Recertification Date
9/5/2024
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
7/5/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PATRICK MCCABE, SENIOR VP FINANCE/CFO
(203) 688-2345
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/5/2017
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