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CYSTIC FIBROSIS SERVICES, LLC
DSH310038 ROBERT WOOD JOHNSON UNIVERSITY HOSP
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Covered Entity Details
Entity Name
ROBERT WOOD JOHNSON UNIVERSITY HOSP
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310038
Entity Address
ONE ROBERT WOOD JOHNSON PLACE
NEW BRUNSWICK, NJ 08901-2601
Medicare Provider Number
310038
Participating Start Date
7/1/2015
Last Recertification Date
8/21/2024
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
Contract Termination Date
Termination Reason
1/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jim Alexander, Vice President, Finance
(732) 418-8064
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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