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CYSTIC FIBROSIS SERVICES, LLC
DSH050060 COMMUNITY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
COMMUNITY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050060
Entity Address
2823 FRESNO STREET
FRESNO, CA 93721
Medicare Provider Number
050060
Participating Start Date
4/1/2007
Last Recertification Date
8/15/2024
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
6/30/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/25/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tracy Kiritani, VP Hospital Financial Operations
(559) 324-4844
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/30/2017
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