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CYSTIC FIBROSIS SERVICES, LLC
CAH061301-00 RIO GRANDE HOSPITAL
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Covered Entity Details
Entity Name
RIO GRANDE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061301-00
Entity Address
310 COUNTY ROAD 14
DEL NORTE, CO 81132
Medicare Provider Number
061301
Participating Start Date
9/9/2010
Last Recertification Date
8/27/2024
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
10/4/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ARLENE HARMS, CEO
(719) 657-4104
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/4/2017
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