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CYSTIC FIBROSIS SERVICES, LLC
FQHC638532 Coquille Indian Tribe
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Covered Entity Details
Entity Name
Coquille Indian Tribe
Subdivision Name
Ko-Kwel Wellness Center
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638532
Entity Address
630 Miluk Drive
Coos Bay, OR 97420
Grant Number
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
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
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelle Little, Health and Human Services Administrator
(541) 888-9494 Ext: 2217
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2017
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