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CYSTIC FIBROSIS SERVICES, LLC
HV00593 St. Mary's Hospital & Medical Center, Inc.
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Covered Entity Details
Entity Name
St. Mary's Hospital & Medical Center, Inc.
Subdivision Name
Ryan White Part C HIV Clinic
Type
Ryan White Part C
340B ID
HV00593
Entity Address
2698 Patterson Road
Grand Junction, CO 81506
Grant Number
H76HA00593
Participating Start Date
10/1/2012
Last Recertification Date
2/24/2025
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
Contract Termination Date
Termination Reason
6/21/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Terri Chinn, CFO
(970) 298-2020
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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