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CYSTIC FIBROSIS SERVICES, LLC
DSH330232 SETON HEALTH SYSTEM
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Covered Entity Details
Entity Name
SETON HEALTH SYSTEM
Subdivision Name
St. Mary's Hospital
Type
Disproportionate Share Hospital
340B ID
DSH330232
Entity Address
1300 MASSACHUSETTS AVE
TROY, NY 12180
Medicare Provider Number
330232
Participating Start Date
10/1/2009
Last Recertification Date
8/28/2018
Entity Termination Date
4/1/2019
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
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2018
Ownership change
Contacts
Covered Entity Signing Official
Lori Santos, CFO
(518) 525-5537
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2018
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