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CYSTIC FIBROSIS SERVICES, LLC
CAH141327-00 Wabash General Hospital District
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Covered Entity Details
Entity Name
Wabash General Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141327-00
Entity Address
1418 College Drive
Mt Carmel, IL 62863
Medicare Provider Number
141327
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
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
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen Douglas McGill, CFO
(618) 263-6305
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2018
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