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CYSTIC FIBROSIS SERVICES, LLC
DSH280081 CHI Health Immanuel
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Covered Entity Details
Entity Name
CHI Health Immanuel
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH280081
Entity Address
6901 N. 72ND ST
OMAHA, NE 68122
Medicare Provider Number
280081
Participating Start Date
4/1/2005
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
7/13/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/9/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TIM SCHNACK, CFO
(402) 572-3701
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2018
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