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CYSTIC FIBROSIS SERVICES, LLC
CAH521322-00 GRANT REGIONAL HEALTH CENTER INC.
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Covered Entity Details
Entity Name
GRANT REGIONAL HEALTH CENTER INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521322-00
Entity Address
507 SOUTH MONROE STREET
LANCASTER, WI 53813
Medicare Provider Number
521322
Participating Start Date
1/1/2018
Last Recertification Date
8/16/2024
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
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dawn M Bandy, CFO
(608) 723-3202
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/16/2018
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