Contract Pharmacy Details

CYSTIC FIBROSIS SERVICES
CH010580 PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE

Covered Entity Details

Entity Name

PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE

Subdivision Name

PROVIDENCE COMMUNITY HEALTH CENTERS, INC.

Type

HRSA-Funded Health Center

340B ID

CH010580

Entity Address

375 Allens Ave
Providence, RI 02905-5010

Grant Number

H80CS00057

Participating Start Date

7/1/1996

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

CYSTIC FIBROSIS SERVICES

Pharmacy Address

CYSTIC FIBROSIS SERVICES, INC
10530 JOHN W ELLIOTT DR, STE 200
FRISCO, TX 75033

Pharmacy Comments

Contract Details

Approval Date

1/15/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/9/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

MERRILL THOMAS, CEO
(401) 444-0400 Ext: 3130

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/15/2016

340B Drug Pricing Program Database