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CYSTIC FIBROSIS SERVICES, LLC
DSH070002 Saint Francis Hospital and Medical Center
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Covered Entity Details
Entity Name
Saint Francis Hospital and Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070002
Entity Address
114 Woodland Street
Hartford, CT 06105
Medicare Provider Number
070002
Participating Start Date
7/1/2012
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
1/17/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sean M Fitzpatrick, Interim Chief Financial Officer
(860) 714-5360
Contract Pharmacy Representative
Walgreens
Thomas Lindstrom, Health Systems Manager
(713) 876-5370
Signed By Date
1/17/2024
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