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CYSTIC FIBROSIS SERVICES, LLC
DSH310014 THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THE COOPER HEALTH SYSTEM DBA COOPER UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310014
Entity Address
ONE COOPER PLAZA
CAMDEN, NJ 08103
Medicare Provider Number
310014
Participating Start Date
1/1/2005
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
7/27/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Douglas E. Shirley, Senior Executive VP and CFO
(856) 342-2443
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/27/2017
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