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CYSTIC FIBROSIS SERVICES, LLC
CH030890 PRESTON TAYLOR COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PRESTON TAYLOR COMMUNITY HEALTH CENTER
Subdivision Name
Preston-Taylor Community Health
Type
HRSA-Funded Health Center
340B ID
CH030890
Entity Address
725 N Pike St
Grafton, WV 26354-1270
Grant Number
H80CS00617
Participating Start Date
7/1/2004
Last Recertification Date
2/26/2025
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
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
June Griffith, COO
(304) 265-0312
Contract Pharmacy Representative
PTCHC
Charles Michael Dickey, Pharmacist
(304) 265-7400
Signed By Date
10/12/2023
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