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CYSTIC FIBROSIS SERVICES, LLC
PED243302-00 Children’s Health Care d/b/a Children’s Minnesota
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Covered Entity Details
Entity Name
Children’s Health Care d/b/a Children’s Minnesota
Subdivision Name
MINNEAPOLIS CAMPUS
Type
Children's Hospital
340B ID
PED243302-00
Entity Address
2525 CHICAGO AVENUE SOUTH
MINNEAPOLIS, MN 55404
Medicare Provider Number
243302
Participating Start Date
1/1/2015
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
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARIA CHRISTU, CHIEF LEGAL OFFICER
(612) 813-6110
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2017
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