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CYSTIC FIBROSIS SERVICES, LLC
DSH060076 STERLING REGIONAL MEDCENTER
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Covered Entity Details
Entity Name
STERLING REGIONAL MEDCENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH060076
Entity Address
615 FAIRHURST STREET
STERLING, CO 80751
Medicare Provider Number
060076
Participating Start Date
1/1/2024
Last Recertification Date
8/23/2024
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
10/31/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DENA KLOCKMAN, CHIEF FINANCIAL OFFICER
(308) 284-7263
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/9/2023
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