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CYSTIC FIBROSIS SERVICES, LLC
CAH221302-00 FAIRVIEW HOSPITAL
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Covered Entity Details
Entity Name
FAIRVIEW HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH221302-00
Entity Address
29 LEWIS AVE
GREAT BARRINGTON, MA 01230
Medicare Provider Number
221302
Participating Start Date
9/27/2010
Last Recertification Date
9/6/2024
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
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DARLENE RODOWICZ, Executive Vice President & Treasurer
(413) 447-2809
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2018
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