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CYSTIC FIBROSIS SERVICES, LLC
CH06031A LAS CLINICA DEL NORTE INCORPORATED
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Covered Entity Details
Entity Name
LAS CLINICA DEL NORTE INCORPORATED
Subdivision Name
LAS CLINICAS DEL NORTE @ OJO CAL
Type
HRSA-Funded Health Center
340B ID
CH06031A
Entity Address
BLDG. # 35282 ON HWY 285
OJO CALIENTE, NM 87549-0307
Grant Number
H80CS00607
Participating Start Date
10/1/1995
Last Recertification Date
2/26/2025
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
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrea Sandoval, CEO
(575) 581-4728 Ext: 253
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/16/2018
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