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CYSTIC FIBROSIS SERVICES, LLC
CAH051335-00 BEAR VALLEY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
BEAR VALLEY COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051335-00
Entity Address
41870 GARSTIN DR
BIG BEAR, CA 92315
Medicare Provider Number
051335
Participating Start Date
7/1/2022
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
7/7/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John Friel, CEO
(909) 878-8214
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/7/2017
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