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CYSTIC FIBROSIS SERVICES, LLC
PED093300-00 Children's National Medical Center
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Covered Entity Details
Entity Name
Children's National Medical Center
Subdivision Name
Type
Children's Hospital
340B ID
PED093300-00
Entity Address
111 Michigan Avenue, NW
Washington, DC 20010-2970
Medicare Provider Number
093300
Participating Start Date
10/1/2012
Last Recertification Date
9/4/2024
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
Kathleen Gorman, EVP, Patient Care services & Chief Operating Officer
(202) 476-2939
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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