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CYSTIC FIBROSIS SERVICES, LLC
DSH050305 Sutter Bay Hospitals, dba Alta Bates Summit Medical Center
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Covered Entity Details
Entity Name
Sutter Bay Hospitals, dba Alta Bates Summit Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050305
Entity Address
2450 ASHBY AVENUE
BERKELEY, CA 94705
Medicare Provider Number
050305
Participating Start Date
7/1/2006
Last Recertification Date
8/27/2024
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
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patti Pilgrim, CFO
(510) 869-8620
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2018
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