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CYSTIC FIBROSIS SERVICES, LLC
HV08103 The Cooper Health System
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Covered Entity Details
Entity Name
The Cooper Health System
Subdivision Name
Early Intervention Program (EIP)
Type
Ryan White Part C
340B ID
HV08103
Entity Address
3 Cooper Plaza, Suite 513
Camden, NJ 08103
Grant Number
H76HA01727
Participating Start Date
2/4/2013
Last Recertification Date
2/11/2025
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
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pamela Gorman, Administrative Director, Early Intervention Program and Infectious Diseases
(856) 963-3833
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2017
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