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CYSTIC FIBROSIS SERVICES, LLC
SCH170023-00 St. Catherine Hospital - Garden City
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Covered Entity Details
Entity Name
St. Catherine Hospital - Garden City
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH170023-00
Entity Address
401 E Spruce St
GARDEN CITY, KS 67846
Medicare Provider Number
170023
Participating Start Date
9/15/2010
Last Recertification Date
9/4/2024
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
AMANDA VAUGHAN, CFO
(620) 272-2554
Contract Pharmacy Representative
Centura Health
VINNY POLITO, SYSTEM DIRECTOR AMB PHARMACY
(303) 673-1014
Signed By Date
7/16/2018
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