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CYSTIC FIBROSIS SERVICES, LLC
CAH061305-00 East Phillips County Hospital District d/b/a MELISSA MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
East Phillips County Hospital District d/b/a MELISSA MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH061305-00
Entity Address
1001 East JOHNSON ST
HOLYOKE, CO 80734
Medicare Provider Number
061305
Participating Start Date
1/1/2015
Last Recertification Date
8/14/2024
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
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/19/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Trampas Hutches, CEO
(970) 854-2241 Ext: 226
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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