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CYSTIC FIBROSIS SERVICES, LLC
HV333113B North Broward Hospital District, d/b/a Broward Health
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Covered Entity Details
Entity Name
North Broward Hospital District, d/b/a Broward Health
Subdivision Name
Bernard P. Alicki Health Center
Type
Ryan White Part C
340B ID
HV333113B
Entity Address
1101 West Broward Boulevard
Fort Lauderdale, FL 33312-1638
Grant Number
H76HA00210
Participating Start Date
4/1/2015
Last Recertification Date
2/26/2019
Entity Termination Date
4/1/2019
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
4/20/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Beth A Cherry, Vice President
(954) 473-3076
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/20/2018
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