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CYSTIC FIBROSIS SERVICES, LLC
FQHCLA412 Lasante Health Center, Inc.
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Covered Entity Details
Entity Name
Lasante Health Center, Inc.
Subdivision Name
Lasante Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA412
Entity Address
672 Parkside Ave
Brooklyn, NY 11226-1506
Grant Number
LALCS31598
Participating Start Date
1/1/2021
Last Recertification Date
2/10/2025
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
4/3/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mordechai Heller, COO
(718) 246-5700 Ext: 120
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/3/2023
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