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CYSTIC FIBROSIS SERVICES, LLC
RRC070017-00 MIDSTATE MEDICAL CENTER
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Covered Entity Details
Entity Name
MIDSTATE MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC070017-00
Entity Address
435 LEWIS AVENUE
MERIDEN, CT 06451
Medicare Provider Number
070017
Participating Start Date
7/1/2025
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
10/20/2022
Contract Begin Date
10/20/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sean Michael Curtin, Vice President, Finance, Hartford Region
(860) 545-0585
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2022
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