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CYSTIC FIBROSIS SERVICES, LLC
CAH501323-00 JEFFERSON HEALTHCARE
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Covered Entity Details
Entity Name
JEFFERSON HEALTHCARE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501323-00
Entity Address
834 Sheridan St
Port Townsend, WA 98368
Medicare Provider Number
501323
Participating Start Date
1/1/2011
Last Recertification Date
8/16/2024
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
7/12/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hilary Whittington, CFO
(360) 385-2200 Ext: 2094
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2017
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