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CYSTIC FIBROSIS SERVICES, LLC
DSH520138 AURORA HEALTH CARE METRO, INC.
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Covered Entity Details
Entity Name
AURORA HEALTH CARE METRO, INC.
Subdivision Name
Aurora St. Luke's Medical Center
Type
Disproportionate Share Hospital
340B ID
DSH520138
Entity Address
2900 W OKLAHOMA AVE
MILWAUKEE, WI 53215
Medicare Provider Number
520138
Participating Start Date
10/1/2010
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
7/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/12/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nanine Nelson, SVP-Finance
(414) 299-1610
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/10/2018
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