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CYSTIC FIBROSIS SERVICES, LLC
RRC500072-00 OLYMPIC MEDICAL CENTER
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Covered Entity Details
Entity Name
OLYMPIC MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC500072-00
Entity Address
939 CAROLINE STREET
PORT ANGELES, WA 98362
Medicare Provider Number
500072
Participating Start Date
10/1/2015
Last Recertification Date
9/3/2024
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
1/4/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Darryl Wolfe, Chief Executive Officer
(360) 417-7705
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/4/2018
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