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CYSTIC FIBROSIS SERVICES, LLC
DSH330236 NewYork-Presbyterian/Brooklyn Methodist
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Covered Entity Details
Entity Name
NewYork-Presbyterian/Brooklyn Methodist
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330236
Entity Address
506 SIXTH STREET
BROOKLYN, NY 11215
Medicare Provider Number
330236
Participating Start Date
10/1/2004
Last Recertification Date
9/6/2022
Entity Termination Date
10/1/2022
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
2/28/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael P. Fagan, Senior VP of Finance
(718) 780-3031
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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