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CYSTIC FIBROSIS SERVICES, LLC
CAH471302-00 WINDSOR HOSPITAL CORPORATION D/B/A MT. ASCUTNEY HOSPITAL AND HEALTH CENTER
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Covered Entity Details
Entity Name
WINDSOR HOSPITAL CORPORATION D/B/A MT. ASCUTNEY HOSPITAL AND HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471302-00
Entity Address
289 COUNTY ROAD
WINDSOR, VT 05089
Medicare Provider Number
471302
Participating Start Date
7/1/2011
Last Recertification Date
8/28/2024
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
6/29/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David C. Sanville, Chief Financial Officer
(802) 674-7240
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/29/2017
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