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CYSTIC FIBROSIS SERVICES, LLC
STD329012 SPEKTRUM Health Melbourne
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Covered Entity Details
Entity Name
SPEKTRUM Health Melbourne
Subdivision Name
FDOH Area 7
Type
Sexually Transmitted Diseases
340B ID
STD329012
Entity Address
1920 South Babcock Street
Melbourne, FL 32901
Grant Number
1H25PS005131
Participating Start Date
8/9/2021
Last Recertification Date
5/8/2024
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
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Anthony Knoll, CEO
(407) 454-1363 Ext: 5001
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2023
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