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CYSTIC FIBROSIS SERVICES, LLC
FQHCLA128 HYGEIA FACILITIES FOUNDATION, INC.
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Covered Entity Details
Entity Name
HYGEIA FACILITIES FOUNDATION, INC.
Subdivision Name
RALEIGH BOONE MEDICAL CENTER
Type
Health Center Program Look-Alike
340B ID
FQHCLA128
Entity Address
37456 COAL RIVER ROAD
WHITESVILLE, WV 25209
Grant Number
LALCS00039
Participating Start Date
4/1/2004
Last Recertification Date
2/27/2023
Entity Termination Date
7/1/2023
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
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Margaret L. Martin, Executive Director
(304) 854-1323
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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