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CYSTIC FIBROSIS SERVICES, LLC
CH08126G MOUNTAIN FAMILY HEALTH CENTERS
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Covered Entity Details
Entity Name
MOUNTAIN FAMILY HEALTH CENTERS
Subdivision Name
MOUNTAIN FAMILY HEALTH CENTERS AVON SCHOOL-BASED HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH08126G
Entity Address
0850 West Beaver Creek Blvd
Avon, CO 81620
Grant Number
H80CS00830
Participating Start Date
1/1/2017
Last Recertification Date
2/11/2025
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
3/6/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/11/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Art M Fernandez, Chief Operating Officer
(970) 945-2840 Ext: 7205
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
3/6/2018
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