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CYSTIC FIBROSIS SERVICES, LLC
CAH381318-00 PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381318-00
Entity Address
810 12th Street
HOOD RIVER, OR 97031-1587
Medicare Provider Number
381318
Participating Start Date
4/1/2011
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
6/28/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeanie Vieira, Chief Operating Officer/Chief Nursing Officer
(541) 387-6452
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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