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CYSTIC FIBROSIS SERVICES, LLC
CAH201310-00 BRIDGTON HOSPITAL
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Covered Entity Details
Entity Name
BRIDGTON HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201310-00
Entity Address
10 HOSPITAL DRIVE
BRIDGTON, ME 04009
Medicare Provider Number
201310
Participating Start Date
8/31/2010
Last Recertification Date
8/30/2024
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
1/8/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Philippe Morissette, VP of Finance
(207) 795-2972
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/8/2018
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