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CYSTIC FIBROSIS SERVICES, LLC
CAH451382-00 Comanche County Medical Center Company dba Comanche County Medical Center
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Covered Entity Details
Entity Name
Comanche County Medical Center Company dba Comanche County Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH451382-00
Entity Address
10201 Highway 16 North
Comanche, TX 76442
Medicare Provider Number
451382
Participating Start Date
7/1/2012
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
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hong Wade, Chief Financial Officer
(254) 879-4900 Ext: 2215
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2023
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