Contract Pharmacy Details

CYSTIC FIBROSIS SERVICES, LLC
DSH470003 UNIVERSITY OF VERMONT MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF VERMONT MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH470003

Entity Address

111 Colchester Avenue
Burlington, VT 05401

Medicare Provider Number

470003

Participating Start Date

4/1/2005

Last Recertification Date

8/28/2024

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

Christina Oliver, VP of Clinical Services
(802) 847-2805

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/16/2017

340B Drug Pricing Program Database