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CYSTIC FIBROSIS SERVICES, LLC
DSH340069 WAKEMED
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Covered Entity Details
Entity Name
WAKEMED
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340069
Entity Address
3000 NEW BERN AVENUE
RALEIGH, NC 27610
Medicare Provider Number
340069
Participating Start Date
1/1/2016
Last Recertification Date
8/14/2024
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
DONALD GINTZIG, President and CEO
(919) 350-8102
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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